Knowledge, Perceptions and Practices of Community Pharmacists Towards Antimicrobial Stewardship: A Systematic Scoping Review

Abstract

The scope of antimicrobial stewardship (AMS) surveys on community pharmacists (CPs) is uncertain. This study examines the breadth and quality of AMS survey tools measuring the stewardship knowledge, perceptions and practices (KPP) of CPs and analyse survey outcomes. Following PRISMA-ScR checklist and Arksey and O'Malley's methodological framework seven medical databases were searched. Two reviewers independently screened the literatures, assessed quality of surveys and KPP outcomes were analysed and described. Ten surveys were identified that assessed CPs' AMS perceptions (n = 7) and practices (n = 8) but none that assessed AMS knowledge. Three survey tools had been formally validated. Most CPs perceived that AMS improved patient care (median 86.0%, IQR, 83.3-93.5%, n = 6), and reduced inappropriate antibiotic use (84.0%, IQR, 83-85%, n = 2). CPs collaborated with prescribers for infection control (54.7%, IQR 34.8-63.2%, n = 4) and for uncertain antibiotic treatment (77.0%, IQR 55.2-77.8%, n = 5). CPs educated patients (53.0%, IQR, 43.2-67.4%, n = 5) and screened guideline-compliance of antimicrobial prescriptions (47.5%, IQR, 25.2-58.3%, n = 3). Guidelines, training, interactions with prescribers, and reimbursement models were major barriers to CP-led AMS implementation. A limited number of validated survey tools are available to assess AMS perceptions and practices of CPs. AMS survey tools require further development to assess stewardship knowledge, stewardship targets, and implementation by CPs.

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

“…Our findings suggest that the current GP-CP collaboration in AMS is a piecemeal process, but increased trust towards each other's professional competency and appreciation of each other's AMS roles might foster good collaboration. The lack of interprofessional trust on, and training to improve, professional AMS competency was consistent with the published literature [20,25]. In the UK, a national consensus-led competency framework has been used to provide a basic set of AMS competencies among undergraduate healthcare professionals including GPs and CPs [26].…”

“…Most GPs and CPs had a good understanding of the objectives and impact of AMS programs although nearly 30% still did not perceive that their individual effort would make a difference in AMR and AMS. This misperception is lower among study CPs compared to the median value of 51.4% derived from 10 CP-AMS surveys around the world [20]. The majority of participating GPs and CPs agreed that they would require adequate training to conduct AMS; interprofessional activities and checklists for AMS were also not in place to collaboratively work with antimicrobial prescriptions.…”

“…Two survey tools were developed involving the representatives from the National Centre for Antimicrobial Stewardship (NCAS) and the Department of General Practice of Monash University. A systematic review of GP-pharmacist collaborative AMS strategies, a scoping review of 10 AMS surveys of CPs, and other AMS surveys of GPs were the sources of the survey items [16,20,47].…”

“…The evidence is growing that GP-pharmacist team-based AMS interventions can optimise antimicrobial use in primary care but the scale of implementation is unclear. [16] Effective interventions include GP-pharmacist group meetings, post-prescription review and feedback, GP-pharmacy practice agreements, point-of-care tests using a collaborative service model, team-based academic detailing, and use of patient forwarding information leaflets [17][18][19][20]. However, the difficulties of GPs and CPs using these strategies in a collaborative fashion are contextual and remain less well understood.…”

A Nationwide Survey of Australian General Practitioners on Antimicrobial Stewardship: Awareness, Uptake, Collaboration with Pharmacists and Improvement Strategies

“…Details of the survey development process are given in the supplementary materials ( Figure S1). The survey questions were developed based on the reviewed literature [34][35][36][37][38][39][40]…”