# Factors Influencing Community Pharmacists’ Participation in Antimicrobial Stewardship: A Qualitative Inquiry

## TL;DR

This study explores why community pharmacists in Australia face challenges in participating in antimicrobial stewardship and suggests changes to improve their involvement.

## Contribution

The study provides new qualitative insights into community pharmacists' perceptions and proposes structural changes to improve antimicrobial stewardship in primary care.

## Key findings

- Pharmacists identified a mismatch between patient clinical needs and practice policies as a major driver of excessive antibiotic use.
- The current funding model discourages pharmacists from engaging in antimicrobial stewardship due to lack of financial incentives.
- Pharmacists suggested changes like limiting antibiotic repeats and shifting to treatment duration-based prescribing to reduce misuse.

## Abstract

Very few studies, all employing surveys, have investigated the perceptions of community pharmacists regarding antimicrobial stewardship (AMS). A qualitative inquiry exploring factors affecting community pharmacists’ participation in AMS may assist in the implementation of AMS in the primary care setting. This study aimed to explore the perceived barriers and enablers of community pharmacists’ participation in AMS. One-on-one semi-structured telephone interviews were conducted with a sample of community pharmacists from across Australia. Interviews were transcribed verbatim and analysed using the Framework Analysis method. Twenty community pharmacists (70% female), representing urban, regional, and remote areas of Australia participated in the study. Pharmacists identified a discord between clinical needs of patients and practice policies as the primary source of excessive prescribing and dispensing of antibiotics. The fragmented nature of the primary healthcare system in Australia was seen as limiting information exchange between community pharmacists and general practitioners about antibiotic use, that was encouraging inappropriate and, at times, unsupervised use of antibiotics. The existing community pharmacy funding model in Australia, where individual pharmacists do not benefit from any financial incentives associated with clinical interventions, was also discouraging their participation in AMS. Pharmacists suggested restricting default antibiotic repeat supplies, reducing legal validity of antibiotic prescriptions to less than the current 12 months, and adopting a treatment duration-based approach to antibiotic prescribing instead of the ‘quantity-based’ approach, where the quantity prescribed is linked to the available pack size of the antibiotic. Structural changes in the way antibiotics are prescribed, dispensed, and funded in the Australian primary care setting are urgently needed to discourage their misuse by the public. Modifications to the current funding model for pharmacist-led cognitive services are needed to motivate pharmacists to participate in AMS initiatives.