The Impact of Pharmacists’ Involvement in Antimicrobial Stewardship (AMS) strategies and potential for role expansion: A qualitative study

Abstract

Background: Antimicrobial resistance (AMR) has negatively impacted patient outcomes and increased healthcare costs. AMS includes all activities and policies to promote judicious use of antimicrobials. Pharmacists are key players in AMS models worldwide. However, there is a research gap in the impact of pharmacists’ roles as antimicrobial stewards in Malaysia and their potential of role expansion. This study aims to qualitatively explore hospital pharmacists’ perspectives on the issue of AMR, the impact they made during implementation of AMS strategies and their visions in role expansion. Methods and materials: Individual, semi-structured interviews were conducted with 16 public hospital pharmacists involved in AMS activities from 13 hospitals in Kuala Lumpur and Selangor from March to July 2018. These audio-taped interviews were transcribed verbatim and imported into NVivo software version 10.0 (QSR). Thematic analysis method was used to identify themes from the qualitative data until theme saturation was reached. Results: The results demonstrated that the respondents have good understandings on the issue of AMR and its impact. They felt injudicious prescribing is one of the main causative factors of AMR. This is further fueled by the lack of public awareness in AMR and the culture of demanding for antimicrobials from healthcare professionals. The involvement of pharmacists was seen as impactful in improving healthcare professionals’ compliance towards principles of good antimicrobial therapy as well as reducing the use of broad-spectrum antimicrobials. The respondents also recognised that their involvement in AMS strategies helped to portray a better professional image of pharmacists. Currently, most pharmacists involved in AMS strategies are ward pharmacists. The respondents envisioned more hospital pharmacists from other units such as inpatient and outpatient pharmacy to be involved and to incorporate AMS principles into their daily practices. Some respondents aspire to take up the role of leading the AMS team, however others disagreed as pharmacists lack the priviledge to diagnose. Conclusion: Public hospital pharmacists have good understandings on the issue of AMR and view themselves as playing impactful roles in AMS team. For future study, views of pharmacists from other regions of the country, private sector, non-ward based pharmacists as well as community pharmacists should be included.