Perceptions, Current Practices and Interventions of Community Pharmacists Regarding Antimicrobial Stewardship: A Qualitative Study in France

Abstract

Background: Community health care accounts for the vast majority of antibiotic use in Europe. Given the threat of antimicrobial resistance (AMR), there is an urgent need to develop new antimicrobial stewardship (AMS) interventions in primary care that could involve different health care providers including community pharmacists. This study aimed to explore the perceptions, currents practices and interventions of community pharmacists regarding antimicrobial stewardship.Methods: Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of community pharmacists combined with a snowballing technique. Interviews were audio recorded, transcribed and analyzed using thematic analysis. The Consolidated Framework for Implementation Research was used while developing the interview guide and carrying out thematic analysis.Results: Sixteen community pharmacists participated. All the respondents had good awareness about antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists’ participation in AMS were identified such as difficult interactions with prescribers, lack of time and lack of access to patient medical records and diagnosis. Increased patient education, audits and feedback of antibiotic prescribing, increased point-of-care testing and delayed prescribing were interventions suggested by the pharmacists to improve antibiotic use in primary care. Strategies cited by participants to facilitate the implementation of such interventions are increased pharmacist-general practitioner collaboration, specialized training, clinical decision support tools as well as financial incentives. Conclusions: This study suggests that community pharmacists could play a greater role in infection management and AMS interventions. Further interprofessional collaboration is needed to optimize antibiotic prescribing and utilization in community health care.

Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries

“…Lack of continuous professional development (CPD) opportunities in LMIC exacerbates drivers of AMR resulting in antibiotics dispensed without prescriptions. The gaps in community pharmacist's knowledge limit their capacity to educate patients on rational medication use [24,25]. Multinational surveys indicates this in Sub-Saharan Africa and Asia [26].…”

A Review on the Role of Community Pharmacists on Antimicrobial Stewardship Programs

“…All the respondents had good awareness of antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists' participation in AMS were identified, such as difficult interactions with prescribers, lack of time, and lack of access to patient medical records and diagnosis [51].…”

“…Nevertheless, AMS strives to enhance patient care and lower healthcare expenditures related to infections through coordinated interventions on the selection, dose, dose regimen, side effects, drug interactions, and allergies to prescribed antibiotics [50]. Community pharmacists' pharmaceutical expertise, as well as their accessibility and close relationship with patients, could promote better utilization of antibiotics by patients and prescribers [51]. Community pharmacists can also play an integral role in AMS programs within community settings, such as delivering value-added services beyond their traditional dispensing duties; they are one of the most frequently seen healthcare professionals and serve as the first point of contact for seasonal viral respiratory tract infections, and community pharmacists are often liaising between patients and various service providers and are well positioned to operationalize any AMS framework [49].…”