Community pharmacists' knowledge about antibiotics and their perceptions of and participation in community-based antimicrobial stewardship programmes: a cross-sectional survey from central China

Abstract

BackgroundAntimicrobial resistance is one of the biggest threats to public health. Improper use of antibiotics, self-medication with antibiotics, sale of antibiotics without a prescription, and inadequate knowledge and training of health-care professionals are major factors contributing to this problem. Community-based antimicrobial stewardship programmes (ASPs) supervised by community pharmacists are important for minimising the progression of antimicrobial resistance. However, little information is available about the involvement of Chinese community pharmacists in community-based ASPs. Therefore, we investigated the knowledge of Chinese community pharmacists about antibiotics and their perceptions of, and participation in, ASPs. MethodsA cross-sectional study was conducted by administering a validated questionnaire to community pharmacists in Xi'an, Shaanxi, central China, between March 1, 2019, and April 30, 2019. A systematic random sampling method was used to recruit registered community pharmacists. Pharmacy technicians were excluded. The questionnaire contained four sections, including one each on demographics, knowledge about antibiotics, perceptions of ASPs, and involvement in ASPs. Responses to sections two, three, and four of the questionnaire were measured by use of the 5-point Likert scale. Descriptive statistics, the Mann-Whitney U test, and Kruskal-Wallis test were used for data analysis. FindingsOf 190 community pharmacists who participated in this study, 154 (81%) were female, 103 (54%) had more than 10 years of experience, and 148 (78%) were working in independent pharmacies. The majority of participants agreed that ASPs improve patient care (146 [77%]) and should be implemented at the community pharmacy level (188 [99%]). 187 (98%) participants believed they should attend workshops and conferences to get a proper understanding about ASPs. 172 (91%) participants said they dispense antibiotics with a valid prescription by considering physician's recommendations. Only 42 (22%) participants said they always consult with other health-care professionals about infection control and ASPs, and 31 (16%) said they always try to reduce the transmission of infections within the community. 105 (55%) participants reported that they often educate patients about the proper use of antimicrobials and problems related to antimicrobial resistance. The median score on the 5-point Likert scale for involvement in ASPs was significantly associated with sex (median score was 4 for women vs 3 for men; p<0·0001). InterpretationIn conclusion, this study revealed the positive attitude of community pharmacists in Xi'an towards community-based ASPs. However, educational interventions for community pharmacists are needed about the core principles of ASPs. Regular training and continuous educational programmes are also recommended. FundingThis work was funded by Young Talent Support Plan, High Achiever Plan of Health Science Center, Xi'an Jiaotong University; Central University Basic Research Fund (grant number 2015qngz05); and Early Career Research Start-up Plan of Xi'an Jiaotong University.