Ms. Dhakshila Niyangoda1,2, Dr Mary Bushell1, Dr Wubshet Tesfaye3, Dr Jackson Thomas1
1Faculty of Health, University of Canberra, Bruce, Australia, 2Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka, 3School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
Biography:
Dhakshila Niyangoda is a Lecturer in Pharmacy at the University of Peradeniya, Sri Lanka and currently studying skin infections in the era of antimicrobial resistance for PhD at the University of Canberra. She is a pharmacist by profession. She has written two book chapters, four journal articles, and presented fourteen conference abstracts. Her research interests include drug discovery, and disease control in primary care.
Abstract:
Little is known about the national challenges faced by Australian primary care clinicians in managing bacterial skin and soft tissue infections (SSTIs). This study explored current practices and investigated barriers and facilitators to evidence-based care. Using a mixed methods approach, we conducted semi-structured interviews and an online survey from October 2022 to May 2024. Thematic analysis was applied to qualitative data, while descriptive statistics and Chi-square (χ²) tests analyzed survey responses.
Sixteen clinicians completed interviews, and seventy participated in the survey, with fifty-one eligible responses. The sample comprised General Practitioners and Nurse Practitioners, representing 100% of interviewees and 88% of survey respondents.
Key themes from the interviews included variations in clinical practices, guideline adherence inconsistencies, reliance on clinical expertise, patient-centred care, and unmet needs. Survey results showed that while most clinicians (79±7%, range: 73%-86%) adhered to Therapeutic Guidelines (eTG) for antibiotics in impetigo, only 41±15% (26%-56%) selected the recommended dosage and frequency. Factors influencing antibiotic selection (62±18%, 32%-90%) included patient-specific factors, antimicrobial resistance (AMR), adverse effects, and local prevalence. Major challenges (30±16%, 20%-59%) included concerns about AMR, diagnostic uncertainty, patient pressure, adverse medication effects, and limited access to diagnostic tests and follow-up.
Despite focusing on patient-centred care, this study revealed significant discrepancies in applying eTG guidelines for bacterial SSTIs. The findings highlight the need for improved adherence to evidence-based guidelines and addressing barriers related to patient, environmental, and drug factors. Further research is needed to develop effective interventions to enhance SSTI management in primary care.