Self-perceived competence on antimicrobial stewardship among government ward pharmacists in Malaysia

Abstract

Background: Pharmacists are widely involved in antimicrobial stewardship (AMS), but there's a paucity of data on their competence in AMS. Hence, this study is aimed to identify self-perceived competence of ward pharmacists in AMS and their predictors. Methods and materials: A cross-sectional survey via questionnaire was conducted online (via email invitation) and by hard copies per request from May to July 2018, involving ward pharmacists from hospitals under Ministry of Health and Hospital Canselor Tunku Muhriz (HCTM). 5-point likert scales were used in 28 questions to assess self-perceived competence. These questions were adapted and modified from the Expert Professional Practice Curriculum for Pharmacists in Infections and AMS by the Royal Pharmaceutical Society. They were categorized into four constructs, namely knowledge (6 questions), confidence (8 questions), attitude (3 questions), and practice (3 questions). Different types of Likert scale option anchors were chosen based on the constructs mentioned (16). Each of the Likert-scale response carries a score, which was calculated in total to reflect the overall self-perceived competence of government ward pharmacists in this study, where higher total scores indicate higher levels of self-perceived competence in AMS. Descriptive statistics, chi-square tests and multiple linear regression were used to analyze the results of the questionnaire. Results: A total of 553 ward pharmacists from 67 hospitals responded to this survey, yielding a response rate of 72.5%. Knowledge on infections, antimicrobials and AMS system, confidence to advise on various issues relating to antimicrobial therapy and participation in clinical audit and evaluation were among the learning needs identified (median score 3.00). Meanwhile, knowledge on epidemiology of infections, off-label uses of antimicrobials, and pharmacoeconomics relating to antimicrobials had lower median scores (2.00) and thus prioritized as high learning needs. Significant predictors of self-perceived competence in AMS were gender (p < 0.001), prior specific training in infections and AMS (p < 0.001), Masters degree and above (p < 0.001), practicing in the area of infectious disease (p < 0.05), and years of working experience as a ward pharmacist (p < 0.005). Conclusion: Findings in this study suggest the necessity to establish and intensify standardized training in AMS among government ward pharmacists.