Barriers and facilitators to antibiotic stewardship in community pharmacy: a qualitative study

Abstract

Content of image described in text. Abstract Background: Efforts to improve antibiotic prescribing in the community have largely focused on physicians; however, pharmacists may represent an untapped opportunity to expand antibiotic stewardship. We sought to understand barriers and facilitators to implementing antibiotic stewardship in community pharmacy settings to identify scalable strategies to improve antibiotic use. Methods: This qualitative study employed semi-structured interviews with community pharmacists, physicians, nurse practitioners, and members of the public. The study was guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Interviews were independently coded by two researchers, and implementation mapping was used to identify potential change strategies. Results: Sixty-five individuals expressed interest, and 35 participated, including 13 community pharmacists, 13 members of the public, and 9 other healthcare providers. Key determinants of community pharmacy stewardship included 1. Patient expectations and public perceptions, 2. Access to clinical information, 3. Communication infrastructure and practices, 4. Interprofessional roles and relationships, 5. Beliefs about community pharmacist capability. Several potential strategies were identified including public awareness campaigns, secure messaging to facilitate pharmacist and prescriber collaboration, showcasing successful examples of community pharmacy antimicrobial stewardship (AMS), and encouraging the inclusion of indications for use on all antibiotic prescriptions. Conclusion: Perceived barriers and facilitators to AMS in community pharmacy settings vary across the public, prescribers, and pharmacists. However, consistent challenges identified included the siloed system of disciplines, lack of direct pharmacist–prescriber communication, and limited access to patient records. These determinants uncovered several potential change strategies that may help improve antibiotic use for patients in the community.