I'll answer that first, but I'm sure Dr. Shevchuk will have other comments.
I sat on the committee to evaluate drugs for Ontario. It oversees the Ontario drug benefit formulary, so I'm quite aware of this problem.
I'll speak a bit to procalcitonin testing, which is not something that's readily available in Canada. In Nordic countries, there are many family physicians who have access to CRP testing and procalcitonin testing, which are important adjuncts in answering, “Is this a virus or a bacteria? Is this an infection or not?”
There is a problem in patient care with the limited resources a family doctor would have, for example. It is through family doctors that most of the over-prescribing is happening, perhaps when they lower their antibiotic use unless they have more technology available. Some of it is inappropriate use, for sure. Some of it is being used for viral infections, which is completely wrong. Some of it is also happening because of a limitation of technology and access to ancillary tests.
The other thing is that I still think punitive strategies don't work. That was cited as a recommendation by somebody. Education may help and guidelines help. Limited-use strategies of the kind we have in Ontario, which require people to fill out a code to use certain antibiotics, may help. I don't think we're ever going to get to zero.
I'd be interested in what Dr. Shevchuk has to say about this, too.