Getting rid of the barriers

What are the barriers currently preventing community pharmacists from playing a more active role in antimicrobial stewardship? New research may provide the answers

Australian community pharmacists are aware of antimicrobial stewardship (AMS) programs and know the importance of sensible use of antimicrobials, but say they have had limited training and resources to play a more active role.

Researchers from Monash University conducted the largest nationwide survey in Australia describing AMS in the context of community pharmacy settings.

Of the 613 pharmacists who responded to the survey, most did not routinely use the known evidence-based AMS strategies.

A range of factors, including lack of training, role definition, tools, access to patients’ records, and information technology facilities were highlighted as preventing community pharmacists from doing systematic AMS activities, they said.

Most respondents had not undertaken education in this area, with only around one-fifth (115, i8.8%) having completed antimicrobial study modules. Another 35 were not aware of these modules existing.

While almost all of the respondents said they often counseled patients and reviewed drug interactions or allergies before dispensing antimicrobials, less than half (45%) used the national Therapeutic Guidelines:
Antibiotic (274 of 602, 45.5%) or assessed guideline-compliance of prescribed antimicrobials (37.9%).

They were also less likely to communicate with GPs when an antimicrobial prescription was believed to be suboptimal, and most (82%) said they perceived that GPs are not “receptive to their intervention regarding the anti-microbial choice and dosage.

Surveyed pharmacists were aware of AMS but “still hold a misperception that their individual efforts have minimal effect in reducing the problem of AMR,” the authors said.

“Community pharmacists did not feel that they had adequate training, resources, guidelines, and
organizational supports to routinely practice AMS”.

However, “most of the respondents were eager to receive relevant education, training, patient communication tools, and a clear protocol on specific AMS tasks and to collaborate with GPs to optimize antimicrobial use,” the authors said.

Initiatives to increase receptiveness of GPs to pharmacists’ recommendations regarding the choice and dose of antimicrobials and a system structure for increased GP-CP collaboration “seem to be a priority to accelerate pharmacist-led AMS implementation”, the authors concluded.

“Most CPs are eager to collaborate with GPs in matters related to AMS but face interpersonal, interactional, and structural barriers including time constraints”. 

“The potentially limited use of point-of-care tests and patient information sheet/leaflets in the study likely reflects the shortage of system structure and facilities to support AMS in community pharmacy. In contrast, the evidence of effectiveness and use of these strategies in routine pharmacy practices is
increasing in the United Kingdom and the United States.

Hence, research to increase the evidence of contextual feasibility of these strategies in Australian community pharmacy settings may be worthy of future investigations,” they said.

The research was published in the Journal of the American Pharmacists Association.

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