Antimicrobial Stewardship in Outpatient Settings: Leveraging Innovative Physician-Pharmacist Collaborations to Reduce Antibiotic Resistance

Abstract

Antibiotic resistance is one of the world's most pressing public health problems. Historically, most drug-resistant bacteria have emerged in hospital settings, yet the vast majority of antimicrobials used in humans in the United States are administered in outpatient settings. Strong collaboration between physicians and pharmacists in the development of antimicrobial stewardship programs in outpatient settings is thus a critical strategy for curtailing antibiotic resistance. Recently, pilot projects have been launched in 3 states that pair physicians and community pharmacists under a Collaborative Practice Agreement (CPA) to treat patients with influenza and group A Streptococcus (GAS) pharyngitis. Under this model, community pharmacists use rapid point-of-care tests to guide clinical decision making and initiate treatment as appropriate under a physician-led, evidence-based protocol. Experience with this research initiative has suggested this model can lead to more judicious use of antibiotics and antivirals, improve public health, and provide safe and convenient care for patients.

Community pharmacists—Leaders for antibiotic stewardship in respiratory tract infection

“…A systematic search of the literature (PubMed) for studies of any design investigating any type of intervention aiming to influence antibiotic use (including prescriptions from doctors, dispensing/sales in community pharmacies or use by patients) identified only three studies describing stewardship‐related interventions by community pharmacists. The studies documented the ability of community pharmacists to: use a point‐of‐care test to reduce antibiotic prescription; provide education to patients; and dispense antibiotics or recommend symptomatic management of patients with urinary tract infection (UTI) . A subsequent study also investigated the effect of pharmacist supply on antibiotic usage for UTI .…”

Pharmacy-based management of influenza: lessons learned from research

“…Of the patients eligible for treatment in the pharmacy, only 11% tested positive to the RIDT; thus, the majority of patients are treated with symptomatic care only . Despite the fact most patients do not leave with an antimicrobial, patient satisfaction rates are high (>90%) . Studies also show pharmacy‐based models increased time to first dose of antiviral …”

“…One example is a pharmacy‐based model to manage patients with influenza. Such models have been explored in Canada, Japan, New Zealand, Norway and various jurisdictions within the United States (U.S) – during both seasonal influenza and during the 2009 H1N1 influenza pandemic. Three primary models of pharmacy‐based influenza management have been reported in the literature (Table ).…”

The Roles of Pharmacy Schools in Bridging the Gap Between Law and Practice

“…For POCT, we published on the patient care outcomes achieved from both the influenza and strep throat testing, the benefits related to enhanced antimicrobial stewardship, the experience and perceptions of patients who received the service, and also the cost-effectiveness. [10][11][12][13][14] The research was disseminated broadly at both state and national meetings and conferences, and generated considerable attention that furthered the movement toward POCT. In addition, research on patient satisfaction of a service, or perceptions of a service (from pharmacists, physicians, public health, etc.)…”