235892 Pharmacists dispensing antibiotics without a prescription: A qualitative pilot study

Monday, October 31, 2011

Mohamed Amin, BPharm, MSc , Social and Administrative Sciences, School of Pharmacy, University of Wisconsin Madison, Madison, WI
Betty Chewning, PhD , University of Wisconsin-Madison, Madison, WI
OBJECTIVES: One of the primary causes of the rise in antibiotic resistance, which can travel the globe, is the inappropriate use of antibiotics. Unlike the United States, pharmacies in Africa, Asia, Europe and South America frequently dispense antibiotics without a prescription (WP). There has been little research, however, about why pharmacists dispense antibiotics WP. This study aimed to identify factors influencing pharmacists' decisions to dispense antibiotics WP in Alexandria, Egypt. METHODS: In January 2010, the primary investigator conducted semi-structured one-to-one face-to-face interviews with open-ended questions using a convenience sample of 7 community pharmacists. Purposive and saturation sampling techniques were applied to identify participants and determine sample size, respectively. Interviews were recorded, translated, transcribed and then analysed independently by the 2 authors. Emerging themes were extracted and analysed using the grounded theory approach. RESULTS: Financial, patron and pharmacist related factors influenced the decision to dispense antibiotics WP. We identified 4 reasons that facilitated dispensing antibiotics WP: (1) profit from selling antibiotics (2) ease of obtaining antibiotic WP from other pharmacies, (3) patron's insistence on getting an antibiotic and (4) patron's inability to access a doctor. On the other hand, pharmacists reported that they would not dispense an antibiotic WP if: (1) the complexity of the patron's condition exceeds a pharmacist's expertise and needs the involvement of a doctor, (2) the requested antibiotic is hazardous or (3) the patron's condition is not worthy of an antibiotic. We identified 5 factors influencing antibiotic product selection. Pharmacists reported that they are more likely to pick a specific antibiotic that is: (1) safe, (2) suitable for the patron's condition, (3) taken in a small number of doses or produces a quick improvement, (4) matched to the patron's financial status,i.e., expensive for rich patrons and cheap for poor patrons and (5) familiar to the pharmacist. Pharmacists' belief that patrons will perceive them as incompetent or unwilling to help if they refuse to dispense an antibiotic WP was cited as a challenge in handling patrons insisting on getting an antibiotic when a pharmacist thinks that antibiotic use is not warranted. CONCLUSIONS: A heterogeneous set of factors influence pharmacists' decisions to dispense antibiotics WP as well as the antibiotic product selection. These factors compromise pharmacists' role in safeguarding the community from inappropriate antibiotic use. Policy makers need to involve pharmacists and patients when promoting the judicious use of antibiotics.

Learning Areas:
Provision of health care to the public
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify factors influencing community pharmacists’ decision to dispense antibiotics without a prescription in Alexandria, Egypt.

Keywords: Antibiotic Resistance, Pharmacies

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have carried out studies that involved irrational use of antibiotics in health facilities in Egypt. I have carried out studies involving community pharmacies in Alexandria, Egypt. I have also analysed qualitative data involving encounters between patients and doctors in the US.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.