Mixed-Method Evaluation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI)

Abstract

The community pharmacy antimicrobial stewardship intervention (PAMSI) is multi-faceted and underpinned by behavioural science, consisting of the TARGET Antibiotic Checklist, staff e-Learning, and patient-facing materials. This mixed-method study evaluated the effect of PAMSI on community pharmacy staffs’ self-reported antimicrobial stewardship (AMS) behaviours. Data collection included staff pre- and post-intervention questionnaires, qualitative interviews, and TARGET Antibiotic Checklists. Quantitative data were analysed by a multivariate ordinal linear mixed effect model; qualitative data were analysed thematically. A total of 101 staff participated from 66 pharmacies, and six completed semi-structured interviews. The statistical model indicated very strong evidence (p < 0.001) that post-intervention, staff increased their antibiotic appropriateness checks and patient advice, covering antibiotic adherence, antibiotic resistance, infection self-care, and safety-netting. Staff reported feeling empowered to query antibiotic appropriateness with prescribing clinicians. The TARGET Antibiotic Checklist was completed with 2043 patients. Topics patients identified as requiring advice from the pharmacy team included symptom duration, alcohol and food consumption guidance, antibiotic side-effects, and returning unused antibiotics to pharmacies. Pharmacy staff acknowledged the need for improved communication across the primary care pathway to optimise antimicrobial use, and PAMSI has potential to support this ambition if implemented nationally. To support patients not attending a pharmacy in person, an online information tool will be developed.

The National Implementation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI) through the English Pharmacy Quality Scheme 2020 to 2022

“…In England, this prompted the development of PAMSI which incorporated the pharmacy AMS e-Learning module, the TARGET Antibiotic Checklist and other educational resources for patients. An evaluation of PAMSI in 2019 and 2020 found that community pharmacy staff reported better understanding of AMR and their AMS role, as well as the confidence to provide self-care and adherence advice to patients, and to discuss clinical aspects of prescriptions with prescribers where needed [ 9 , 10 ]. These findings led to the national scale up and implementation of the revised AMS e-Learning module as well as the Antibiotic Guardian campaign through the PQS in 2020/21, which was an important first step to ensure the workforce had the necessary capabilities before introducing the TARGET Antibiotic Checklist the following year.…”

“…A follow-up questionnaire hosted on SnapSurvey (Snap11 professional) collected feedback from a sample of staff about their experience of using the TARGET Antibiotic Checklist as part of the 2021/22 PQS ( Supplementary file S2 ). Questions were based on a previously published evaluation and were co-designed and piloted with pharmacists [ 10 ]. The survey was open from July to October 2022.…”

“…The pharmacy antimicrobial stewardship intervention (PAMSI) was co-developed with pharmacy staff and other key stakeholders [ 9 , 10 ]. It is based on the capability, opportunity, motivation and behaviour (COM-B) behavioural model [ 11 ], and consists of the TARGET Antibiotic Checklist [ 12 ], the ‘AMS for Community Pharmacy’ e-Learning module [ 13 ], the Antibiotic Guardian pledge [ 14 ] and a selection of TARGET information leaflets for patients which include self-care and safety-netting advice for common infections [ 15 ].…”

“…A section for patients requires them to report their infection, risk factors (such as liver or kidney issues), allergies, and knowledge of antibiotics, which is used by the pharmacy team to tailor their clinical assessments and counselling to patients [ 9 , 12 ]. In this way, the TARGET Antibiotic Checklist provides a framework for AMS actions in the community pharmacy, overcomes barriers around not knowing the patient’s indication for the antibiotic, and provides an opportunity to deliver structured counselling to the patient based on their perceived knowledge gaps [ 9 , 10 ]. PAMSI was evaluated with a sample of staff from a national chain in the UK in 2020.…”

“…PAMSI was evaluated with a sample of staff from a national chain in the UK in 2020. The evaluation found significant improvements in AMS activities reported by community pharmacy staff following the intervention, including checking whether antibiotic prescriptions are appropriate and following local and national guidelines [ 10 ].…”