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Trial registered on ANZCTR
Registration number
ACTRN12624001011572
Ethics application status
Approved
Date submitted
30/07/2024
Date registered
20/08/2024
Date last updated
20/08/2024
Date data sharing statement initially provided
20/08/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
The Optimal Implementation of Antimicrobial Stewardship In General Practice Study (OptimasGP) - Pilot study
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Scientific title
The Optimal Implementation of Antimicrobial Stewardship In General Practice Study (OptimasGP) - Pilot study
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Secondary ID [1]
312650
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MRFF project 2029531
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Universal Trial Number (UTN)
U1111-1311-3260
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Trial acronym
OptimasGP Pilot
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Antimicrobial stewardship
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Condition category
Condition code
Public Health
331197
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0
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Health service research
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intervention
GPs will use the online AMS Toolbox to support them to provide standard of care when consulting adult patients with acute respiratory infections who would normally seek treatment from their GP. Patients with acute respiratory tract infections will attend their GP as they normally would e.g. booking in, paying the normal amount for a consultation if required.
Examples of the resources included in the AMS Toolbox include the CDC Delayed Prescribing tool, the Australian Commission on Safety and Quality in Healthcare's Decision Aid for acute bronchitis, the National Institute for Health and Care Excellence's Cough (Acute): Antimicrobial Prescribing tool, and a treatment plan developed by University of Wollongong researchers through co-design.
During consultations, GPs will use the AMS Toolbox to record having seen an adult patient with a respiratory infection (no patient details are collected) and whether or not they prescribed an antibiotic. If the GP considers it clinically appropriate, they can choose one of the AMS Toolbox resources to support their standard clinical care. The AMS Toolbox will include resources for shared decision making, clinical decision-making support with the addition of point-of-care testing if appropriate, and delayed prescription. These resources will be available online and in hard copy. GPs are able to share these resources with patients if desired. GPs will decide which resource to use, if any, during the consultation. Use of the AMS Toolbox is expected to take 5-10 minutes per consultation depending on which AMS resources are used. The decision to prescribe an antibiotic or not is completely up to the GP and patient.
Patients may be offered a point-of-care testing to inform clinical decision making. The decision to conduct a point-of-care test will be made by the GP and the patient together using a clinical decision making guide. This test will require a finger prick test – this is entirely voluntary and is a standard method used to obtain blood for routine tests in general practice such as blood glucose tests. Approximately 3 drops of blood will be removed by finger stick. Blood will be tested using a point of care testing device using standard procedures. Results from this test are not recorded as part of the trial, and are only used as part of the clinical decision making process. There will be no additional charge to the patient for the test.
Point-of-care testing will be for C-reactive protein (CRP). A CRP level of <20mg/l indicates that bacterial infection is unlikely and provides support for not prescribing an antibiotic. A CRP level of 20-100mg/l suggests a bacterial infection may be possible and an antibiotic could be prescribed in consideration with other factors, while a CRP rating above 100mg/l suggests the infection is bacterial and an antibiotic should be prescribed.
Two point-of-care testing devices will be piloted: an Affinion 2 analyser and a Quikread Go. Both devices are approved by the Australian Therapeutic Goods Agency and are currently available to GPs who wish to buy them. Each device will be used by one of the six practices for a month after which time it will be moved on to the next practice i.e. each of the six practices will use a POCT device for a month. Training on the use of the devices will be included as part of the GP pre-trial training.
Adherence will be monitored using 1) qualitative interviews at the end of the study, 2) a comparison of the rates of data entry into the AMS Toolbox vs an audit of practice data.
The implementation support offered to GPs
- Change in workflow: the AMS Toolbox will centralise intervention resources to make them more accessible
- Reminder: A small post-card sized card will be given to each GP to remind them to complete their data analysis.
- Training: Two hours of online videos will be provided by members of the research team. This will recorded videos and are expected to be viewed in 1-2 sessions.
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Intervention code [1]
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Behaviour
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Intervention code [2]
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Treatment: Other
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Acceptability of implementation resources
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Assessment method [1]
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Members of the research team will conduct 90min online interviews with general practitioners and healthcare workers. These will be structured interviews using an interview guide. Interviews will be audio-recorded and transcribed.
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Timepoint [1]
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At conclusion of 3 month trial
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Secondary outcome [1]
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To measure rates of recruitment
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Assessment method [1]
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Recruitment numbers - assessed through an audit of study records
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Timepoint [1]
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Finalized at conclusion of the study
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Secondary outcome [2]
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Patient acceptability of Pateint reported outcome measures survey (PROMs) and Patient reported experience (PREMs) survey - this will be assessed as a composite measure
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Assessment method [2]
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Surveys has been designed for this study based on
Benson and Benson (2023). Routine measurement of patient experience. BMJ Open Qual 2023 Vol. 12 Issue 1
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Timepoint [2]
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Throughout study
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Secondary outcome [3]
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Retention rates
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Assessment method [3]
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Completion rates assessed through an audit of study records
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Timepoint [3]
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Finalized at conclusion of the study
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Eligibility
Key inclusion criteria
For participating practices:
- Medical practices in NSW
For participating general practitioners:
- Working in general practice for at least three days a week at participating location
For participating patients:
- 18 or older
- Attended a GP for a respiratory tract infection
- Was provided with a study information card
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
None
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
4/09/2024
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Actual
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Date of last participant enrolment
Anticipated
30/11/2024
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Actual
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Date of last data collection
Anticipated
28/02/2025
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Actual
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Sample size
Target
12
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Department of Health and Aged Care - MRFF Clinical Trials Activity [Stream 2] 2023
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Address [1]
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Country [1]
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Australia
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Primary sponsor type
University
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Name
University of Wollongong
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
319337
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Country [1]
319337
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Joint University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee
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Ethics committee address [1]
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http://www.uow.edu.au/research/ethics/index.html
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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24/05/2024
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Approval date [1]
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23/07/2024
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Ethics approval number [1]
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2024/171
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Summary
Brief summary
This program of research aims to safely reduce antibiotic use by supporting the implementation of best-practice Antimicrobial stewardship guidelines in general practice. These resources will support GPs treating adults with acute respiratory infections (ARIs). A UOW research team and collaborators, led by Profs Andrew Bonney and Judy Mullan, has been successful in being awarded a Medical Research Futures Fund grant (ID: MRF2029531) to conduct this research. This study is called the Optimal Implementation of Antimicrobial Stewardship in General Practice (OPTIMAS-GP) study. This pilot study will inform a larger randomised control trial.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Andrew Bonney
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Address
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University of Wollongong, Graduate School of Medicine, George Evans Rd, West Nowra, NSW 2541
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Country
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Australia
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Phone
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+61 02 42215473
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Colin Cortie
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Address
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University of Wollongong, Graduate School of Medicine, George Evans Rd, West Nowra, NSW 2541
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Country
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Australia
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Phone
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+61 02 42215610
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Colin Cortie
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Address
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University of Wollongong, Graduate School of Medicine, George Evans Rd, West Nowra, NSW 2541
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Country
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Australia
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Phone
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+61 02 4221 5610
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Fax
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
All data collected will be available in de-identified form.
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When will data be available (start and end dates)?
Data will be available from 30 July 2025 for 15 years.
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Available to whom?
Data will be available to researchers who provide a methodologically sound proposal and are willing to be added to the existing ethics application.
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Available for what types of analyses?
Data will be available only to achieve the aims in the approved proposal due to ethical considerations.
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How or where can data be obtained?
Access subject to approvals by Principal Investigator, Professor Andrew Bonney (
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
24053
Ethical approval
388221-(Uploaded-30-07-2024-12-29-12)-HREC Approval of Application 2024_171_Optimal Implementation of Antimicrobial Stewardship in General Practice Study-Pilot Study.pdf
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF