Antimicrobial resistance (AMR) is a growing and under-recognised health threat in rural and remote Australia, where infection risks are high and healthcare access is limited – and Flinders University researchers have received almost $5 million from Australia’s Medical Research Future Fund (MRFF) to address this antibiotic dilemma.
Shortcomings in remote area diagnosis mean that 26% of antimicrobial prescriptions in remote primary healthcare clinics are deemed unsuitable, leading to AMR rates for common bacteria being up to four times the national average. This disproportionately affects First Nations communities and places significant strain on the healthcare system.
The MRFF Rapid Applied Research Translation project – headed by Dr Danny Tsai, a Flinders Research Pharmacist based at Centre for Remote Health and Alice Springs Hospital – will address the fundamental issues that drive AMR and design more efficient prescription of effective antibiotics.
“It’s a complex problem. Over-prescription of antimicrobials is driven by concerns of undertreatment in remote settings, limited access to specialist support, insufficient knowledge of AMR, geographic isolation from tertiary care centres and constrained healthcare resources,” explains Dr Tsai.
While clinician-led Antimicrobial Stewardship (AMS) programs in NT hospitals have successfully delivered hospital-based programs that have improved antimicrobial usage and prescribing through multimodal strategic activities such as education activities, antimicrobial prescribing surveillance and directed clinical support, similar success now need to be replicated in remote areas that do not have the same health services.
Dr Tsai is confident the new project will enable a comprehensive AMS program in remote NT locations, with surveillance tools, virtual clinical support, targeted education, culturally-appropriate health promotion and horizon scanning for emerging AMR threats.
The project – “Tackling Antimicrobial Resistance in Remote Australia” (TARRA) – will examine how to combat increasing Antimicrobial Resistance to bacterial infections among Indigenous people in remote areas who have limited access to health care.
Because of fears that these patients are in danger of being under-treated, they are instead overprescribed with medications that are unsuitable, which ultimately leads to added burden on health care resources and inflated costs.
“We need to provide more advice to the people prescribing medicines in remote areas – who are often remote area nurses or Aboriginal health practitioners, due to a shortage of doctors in remote Australia,” explains Dr Tsai. “They will benefit greatly from the introduction of hospital principals to remote settings.”
“We need to make this comprehensive, so that all health care workers and patients are equipped with more information about effective medications.”
The project will design a remote AMS Program that can guide the adaptation of an existing hospital-based AMS model and digital platform to be effective in remote NT primary healthcare settings – and include such functions such as antimicrobial usage surveillance, a Clinical Decision Support System tailored to local guidelines, and digitised culturally appropriate medicine resources.
A clinical audit tool will also be customised for remote use, with education and health promotion materials developed to support health providers and improve community health literacy around infections, treatments and AMR.
The blueprint laid out by this new research project will serve as an operational framework for other remote primary healthcare settings with similar demographics, providing guidance on AMS implementation and surveillance strategies.
Investigating more effective antibiotic and pharmaceutical health solutions for Indigenous people has become a primary focus for Dr Tsai, and his contributions to Indigenous Health Research in the Northern Territory are having a telling effect on improving health outcomes for people living in remote areas.
For the sum of his research work and practical application of his findings, Dr Tsai received the SA/NT Pharmacist of the Year Award at the 2019 Annual Celebration of Excellence in Pharmacy, and NT Allied Health Excellence in Research Award in 2023, and was commended for his significant contribution to the safe and effective use of medicines in Aboriginal and Torres Strait Islander people, along with improving clinical pharmacy services in Central Australia.
He began focusing his research in this area after seeing a vast number of Indigenous patients at Alice Springs Hospital, who comprise more than 85% of inpatients – not only for treatment of chronic illnesses, but also viruses and infections that had become septic.
“I could see that some patients with critical illness weren’t responding to standard doses of antibiotics, so I began to ask whether they were receiving appropriate doses, or whether our instructions were outdated. I realised there was so much we didn’t know about the specific physiology of the people we were trying to help – and this became a primary focus of my research work,” he says.