Dr Trent Yarwood1,8,9,10 Dr Daniel Stefanski1,2, Ms Sahra Ashley1, Mr Hunter Scammell1, Dr Minyon Avent1,4, Ms Bonnie Smith1, Ms Stacey McNamara1, Dr Kathryn Daveson5,6, Dr Krispin Hajkowicz7,4,
1Queensland Statewide Antimicrobial Stewardship Program, Brisbane, Australia,
2Gippsland Infectious Diseases, Gippsland, Australia,
3Queensland Childrens Hospital, South Brisbane, Australia,
4Centre for Clinical Research, University of Queensland, Brisbane, Australia,
5Australian Commission for Safety and Quality in Healthcare, Sydney, Australia,
6Infectious Diseases Unit, Canberra Hospital, Canberra, Australia,
7Infectious Diseases Unit, Royal Brisbane and Womens’ Hospital, Brisbane, Australia,
8Rural Clinical School, University of Queensland, Cairns, Australia,
9College of Medicine and Dentistry, James Cook University, Cairns, Australia,
10Infectious Diseases Unit, Cairns Hospital, Cairns, Australia
Antimicrobial resistance is recognised as a major threat to health and to the sustainability of modern healthcare. Antimicrobial stewardship (AMS) programs are an important strategy to optimise antibiotic use, and have been shown to reduce patient morbidity and mortality through improved use of antimicrobials.
AMS programs are frequently directed by specialist infectious diseases physicians or clinical microbiologists, with the support of specialist antimicrobial pharmacists. However, these highly specialised staff are usually based in larger, often metropolitan centres. Surveillance data suggest that rates of some drug-resistant pathogens may be higher in rural and remote areas, and that there is significant difference in patterns of antimicrobial use between remote and metropolitan areas. Resources and staffing are constrained in remote areas – with few (if any) pharmacists or infection control practitioners.
We report on the implementation of a regional/remote hospital antimicrobial stewardship program, delivered predominantly via telehealth, and some of the lessons learnt during this process.
Antimicrobial stewardship is a critical tool to implement across the healthcare system, and the different nature of healthcare in regional and remote areas requires an approach very different to that used in metropolitan hospitals. A statewide program of this kind can be successfully delivered via telehealth from a larger centre, providing improved patient care and cost savings to regional health services. Similar programs should be considered as an important step towards equity for patients living in other rural and remote areas.
Trent Yarwood is an infectious diseases physician, who practices in Cairns, and is the clinical director of the Queensland Statewide Antimicrobial Stewardship Program. His clinical interests include HIV medicine, infection prevention, the public health management of drug-resistant infection and digital health. He is a Senior Lecturer with the University of Queensland’s Rural Clinical School and James Cook University’s College of Medicine and Dentistry, and senior medical advisor to Future Wise Australia.