A Nationwide Survey of Australian General Practitioners on Antimicrobial Stewardship: Awareness, Uptake, Collaboration with Pharmacists and Improvement Strategies

Round 1

Reviewer 1 Report

This manuscript addresses the critical professional collaborations between general practitioners (GPs) and pharmacists that are critical for maintaining and constantly improving effective antimicrobial stewardship (AMS) for patient care at both local and national levels.   The nationwide survey found that most medical practitioners in Australia are aware of the importance and the uptake of AMS principles in clinical practice and highlights the need for constant GP-pharmacist communications and the necessary collaborations to maintain effective surveillance of antimicrobial resistance and the selection of effective antimicrobial treatment strategies.

Additional Review Comments:

1. This manuscript describes the findings of a landmark
   Australia-wide study that was designed and conducted by a joint
   team of investigators representing Australian general
   practitioners(GPs) and pharmacists who assessed general
   practitioners' awareness of AMS, the uptake of AMS strategies, and
   the attitudes towards GP-pharmacist collaboration for improving AMS
   in Australia.

2. These study findings are being used in a framework to improve
   physician/pharmacist communication and to coordination for AMS in
   Australia, which is essential for more effective diagnosis,
   treatment and control of infectious diseases in the country.
   The study findings are also being used to inform improvements in
   physician/pharmacist communication that is necessary for AMS.

Author Response

Thank you so much for recognising the importance of GP-Pharmacist collaboration to improve AMS and appreciable comments on our study.

1. This manuscript describes the findings of a landmark 
   Australia-wide study that was designed and conducted by a joint 
   team of investigators representing Australian general 
   practitioners(GPs) and pharmacists who assessed general 
   practitioners' awareness of AMS, the uptake of AMS strategies, and the attitudes towards GP-pharmacist collaboration for improving AMS in Australia.

Thanks for your comment.

2. These study findings are being used in a framework to improve 
   physician/pharmacist communication and to coordination for AMS in Australia, which is essential for more effective diagnosis, 
   treatment and control of infectious diseases in the country. 
   The study findings are also being used to inform improvements in 
   physician/pharmacist communication that is necessary for AMS.

We appreciate your point about the use of the findings as a framework to improve GP-pharmacist co-ordination, communication and collaboration in Australia to foster AMS in the country.

Reviewer 2 Report

Comments for the authors -

Antimicrobial resistance is the most important criteria for widespread infections across the world. Therefore, the antimicrobial stewardship programs from the health care system in developing nations is a welcome step.

The current paper is well written and the questionnaires are well formulated. Structure of study and data assessment is commendable. Important considerations for dissemination of information on antimicrobial stewardship like literature, method of presentation etc. have been carefully structured.

The authors have strived to register a larger cohort of GPs (~2500) and pharmacists for the survey study but the collected data (385) was dependent on the number of positive completed survey responses to initial invites.

As per this number of positive responses (15%) to the survey, the demographic characteristics obtained are valid as a representative example, but a higher number was desirable. As pointed out by the authors themselves, the GPs participation in the survey was voluntary and hence only those interested in AMS may have responded.

Shortcomings in this have been highlighted. The possible reasoning for non-participation of GPs in such surveys was mentioned and compared with previous studies. Although, the receptive GP attitudes reported in the present survey are encouraging for training and better disseminating of AMS. A mechanism to ensure better GP participation in such surveys could be put in place by seeking positive responders to recommend other peers to participate. Other means of communication via social media interaction, networking could be helpful. Authors can suggest/ implement new methods for improving response ratio for future surveys.

Overall AMS policy decisions by reward or penalty system on the GPs maybe essential to enforce regulations in daily practice/primary care.

Corrections-

References citations from 1-16 is seen in introductory section. Discussion section has ref from Number 31-46. The reference number 17-30 are in material and methods and look disconnected. It would be better to format numbering of references as per order of appearance in text.

Author Response

Thank you so much for your commendable comments with regards to the study design, structure, data collection, dissemination and importance of the work.

As per this number of positive responses (15%) to the survey, the demographic characteristics obtained are valid as a representative example, but a higher number was desirable. As pointed out by the authors themselves, the GPs participation in the survey was voluntary and hence only those interested in AMS may have responded.

Appreciate your comments around representativeness of our study samples in Australia.

Shortcomings in this have been highlighted. The possible reasoning for non-participation of GPs in such surveys was mentioned and compared with previous studies. Although, the receptive GP attitudes reported in the present survey are encouraging for training and better disseminating of AMS. A mechanism to ensure better GP participation in such surveys could be put in place by seeking positive responders to recommend other peers to participate. Other means of communication via social media interaction, networking could be helpful. Authors can suggest/ implement new methods for improving response ratio for future surveys.

We highly appreciate your suggested strategies of how to improve GPs' response rate in future as this is a major problem in primary care survey. We have included these strategies at the end of the limitation section as follows.

'To improve the response rate, the future survey might consider some other strategies; requesting GPs to recommend other peers to participate, using social media interactions and networking.'

Overall AMS policy decisions by reward or penalty system on the GPs maybe essential to enforce regulations in daily practice/primary care.

We agree that the reward or penalty system on the GPs can make a difference in the quality of antibiotic prescribing by GPs.

References citations from 1-16 is seen in introductory section. Discussion section has ref from Number 31-46. The reference number 17-30 are in material and methods and look disconnected. It would be better to format numbering of references as per order of appearance in text.

The numbering of references have been formatted.