Antibiotic Dispensing Education Essential for Pharmacists

Pharmacists’ antibiotic dispensing practices are improved through multifaceted educational interventions, according to a review published in BMC Public Health.

Researchers from Portugal and Spain conducted a systematic review of relevant literature on antibiotic prescribing and dispensing practices. The review focused on studies involving primary care and hospital settings between January 2001 and December 2011, in order to determine methods to help prevent inappropriate antibiotic use. A total of 78 studies were eligible for analysis, among which 47 were conducted in primary care settings and 31 in hospital settings.

The studies measured adherence to guidelines and/or total antibiotics prescribed, in addition to attitudes about antibiotic prescribing and the quality of antibiotic-related pharmacy practice. Although they varied widely in design, the studies reported generally positive results overall.

The educational interventions observed across the studies were broken down into the following categories:

• Dissemination of printed and/or audiovisual educational materials, such as mailed printed matter, protocol guidelines, self-instruction materials, and drug bulletins
• Group education, including group session rounds, conferences, lectures, seminars, and tutorials
• Feedback of physician prescribing patterns or patient-specific lists of prescribed medications
• Individual outreach visits
• Reminders at the time of prescribing
• Computer-assisted decision-making systems
• Formulary control/restrictive formulary process
• Patient education via pamphlets or videotapes
• Workshops on rapid tests or the introduction of Rapid Antigen Detection Testing in consulting offices
• Enforcement of regulations
• Prescription feedback with recommendations to modify made by pharmacists and/ or infectious disease physicians
• Financial incentives

In primary care, 33 studies (70%) focused on the use of antibiotics in respiratory infections, while the remaining 30% did not designate any target disease. Of the 47 papers, 27 (57%) evaluated the effectiveness of 1 or more interventions compared with nonintervention. About two-thirds (62%) of the studies demonstrated positive post-intervention results for all outcomes examined, 14 (30%) reported positive impacts on some outcomes, and only 4 failed to report significant improvements on all endpoints.

The hospital studies generally examined more pre- and post-intervention data in order to assess whether a reduction in antibiotic use might cause clinical alterations, whereas only 3 studies in the primary care setting analyzed clinical outcomes. Many of the hospital studies seemed to highlight the role of clinical pharmacists in designing and implementing guidelines and policies for antibiotic use in such settings, the researchers noted.

“Improvement in adherence to guidelines and decrease of total of antibiotics prescribed, after educational interventions, were observed, respectively, in 46% and 41% of all the reviewed studies. Changes in behavior related to antibiotic prescribing and improvement in quality of pharmacy practice was observed, respectively, in 4 studies and 1 study,” the authors concluded. “…Educational interventions to improve antibiotic use are essential.”