'Struggling to be a defender of health' -a qualitative study on the pharmacists' perceptions of their role in antibiotic consumption and antibiotic resistance in Romania.

I Ghiga,C Stålsby Lundborg

doi:10.1186/s40545-016-0061-y

Abstract

BackgroundAntibiotic resistance is a serious global public health problem directly correlated to high antibiotic consumption. Romania is one of the European countries with the highest rates of antibiotic consumption, non-prescription antibiotics use and resistance of several pathogens to antibiotics. Pharmacists are an important stakeholder in respect to antibiotic management and context specific research on this topic is needed.The aim of the research is to increase the understanding of how community pharmacists in Romania perceive their roles in respect to antibiotic consumption and antibiotic resistance.Semi-structured interviews with 18 pharmacists were conducted to explore the perceptions and attitudes of pharmacists towards their roles on antibiotics consumption and antibiotic resistance. Manifest and latent qualitative content analysis was used to analyse interview transcripts.ResultsThree sub-themes emerged from the analysis. ‘Maintaining equilibrium between ethics, law and economy’ expresses how pharmacists often feel when trying to fulfil their duties considering all the dimensions of the pharmacist profession.‘ Antibiotic resistance problem rooted in a low social capital environment’ reflects the pharmacists’ perceptions of the deep causes of antibiotic resistance and the underlying problems that perpetuate the status quo and impact their role in relation to this problem. Wanting to fulfil their educational role illustrates how the pharmacists feel they could best contribute to improving the present situation. The overarching theme ‘Undervalued medicines’ professionals struggling with agency related and structural barriers to meet their deontological duties’- meaning the ethical responsibilities that come with the pharmacy practice, reflects that the pharmacists see their roles as being challenged by several barriers.ConclusionsA health system and societal context perspective is helpful in order to understand the pharmacists’ roles in respect to antibiotic consumption and antibiotic resistance. Health promotion interventions and policy revisions should take into account concepts of structure and agency. These could highlight barriers that pharmacists encounter in their activities related to antibiotics management.

Highlights

Antibiotic resistance is a serious global public health problem directly correlated to high antibiotic consumption
The sale of antibiotics over the internet is prohibited. With all this background we explored the perceptions of Romanian pharmacists, when it comes to the role they play in antibiotic consumption and antibiotic resistance
The subtheme is based on the following categories: (1) Health system barriers that the patients face in accessing care, (2) The patient’s health comes first and (3) Facing negative incentives that determine a pharmacist to push the limits of law

Summary

Introduction

Antibiotic resistance is a serious global public health problem directly correlated to high antibiotic consumption. The aim of the research is to increase the understanding of how community pharmacists in Romania perceive their roles in respect to antibiotic consumption and antibiotic resistance. Semi-structured interviews with 18 pharmacists were conducted to explore the perceptions and attitudes of pharmacists towards their roles on antibiotics consumption and antibiotic resistance. Antibiotic resistance is a serious global health problem and there is wide consensus that the major cause of antibiotic resistance development is use of antibiotics [1]. The WHO Regional Office for Europe has undertaken a study investigating the role of pharmacists in respect to encouraging prudent use of antibiotics and prevention of antibiotic resistance emergence and found that pharmacists are among the best positioned health professional group to tackle antibiotic resistance [1]. From a pharmacist’s point of view, dispensing antibiotics upon request to patients that selfmedicate can be influenced by them knowing the patient –leading to complacency to patient’s request as shown by research conducted in Spain [8] and Portugal [9] or it can be a consequence of insufficient knowledge from the pharmacist’s side [9, 10].

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