Microbiology; Immunology and Allergy; Immunology; Microbiology (medical); Infectious Diseases
Abstract :
[en] [en] BACKGROUND: Antibiotics are widely overused, with over 25% of prescriptions in primary care deemed unnecessary or inappropriate. In France, as in many countries, community pharmacists (CPs)-often in collaboration with prescribers-can modify inappropriate prescriptions or refuse to dispense antibiotics through pharmaceutical interventions (PIs). However, the role of PIs and the clinical reasoning underpinning pharmacists' decisions remain poorly described.
AIM: To identify the factors considered by CPs when making PIs related to antibiotic dispensing, and to explore how these factors influence their practice.
METHODS: This qualitative study involved face-to-face interviews with French CPs. Data were analysed thematically using an integrative approach by two independent researchers.
RESULTS: Fifteen interviews were conducted, with data saturation reached after the 10th. PIs followed several steps: identifying the need for intervention, proposing therapeutic alternatives where necessary, contacting the prescriber, ensuring traceability, dispensing antibiotics and providing patient counselling. Pharmacists' clinical reasoning was influenced by factors related to patients, prescribers, their professional environment and broader contextual elements. Some factors were specific to antibiotics, while others were more general.
CONCLUSIONS: PIs enable CPs to address inappropriate antibiotic prescribing and reduce unnecessary dispensing in outpatient settings. A better understanding of the factors influencing pharmacists' clinical reasoning-such as patient-related, prescriber-related and contextual determinants-could inform strategies to improve antibiotic use. These insights should be integrated into pharmacy education and professional development.
Disciplines :
General & internal medicine Pharmacy, pharmacology & toxicology
Author, co-author :
Slekovec, Céline; Faculty of Health Sciences, University Marie and Louis Pasteur, Besançon, France ; Infection Prevention and Control Department, University Hospital, Besançon, France ; UMR 6249 CNRS Chrono-environnement, University Marie and Louis Pasteur, Besançon, France
Joly, Louise ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale ; Department of General Practice/Family Medicine, Research Unit Primary Care & Health, Liège, Belgium
Pelaccia, Thierry; Center for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, University of Strasbourg, Strasbourg, France ; Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
Language :
English
Title :
How can community pharmacists improve antibiotic use among outpatients? A qualitative study of pharmacists' clinical reasoning.
Naylor NR, Atun R, Zhu N et al. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrob Resist Infect Control 2018; 7: 58. 10.1186/s13756-018-0336-y
European Center of Diseases Control. Antimicrobial Consumption in the EU/EEA (ESAC-Net) - Annual Epidemiological Report for 2023. 2024. https://www.ecdc.europa.eu/en/publications-data/antimicrobial-consumption-eueea-esac-net-annual-epidemiological-report-2023.
Cassir N, Di Marco J-N, Poujol A et al. Prescriptions inappropriées d'antibiotiques chez l'enfant en médecine de ville: raisons et conséquences. Arch Pédiatrie 2012; 19: 579-84. 10.1016/j.arcped.2012.03.012
Etienne C, Pulcini C. Évaluation prospective des prescriptions antibiotiques d'un échantillon de médecins généralistes français. Presse Médicale 2015; 44: e59-66. 10.1016/j.lpm.2014.07.022
White AT, Clark CM, Sellick JA et al. Antibiotic stewardship targets in the outpatient setting. Am J Infect Control 2019; 47: 858-63. 10.1016/j.ajic.2019.01.027
Frost HM, Hersh AL, Hyun DY. Next steps in ambulatory stewardship. Infect Dis Clin North Am 2023; 37: 749-67. 10.1016/j.idc.2023.07.004
Kitano T, Langford BJ, Brown KA et al. The association between high and unnecessary antibiotic prescribing: a cohort study using family physician electronic medical records. Clin Infect Dis 2021; 72: e345-51. 10.1093/cid/ciaa1139
Zhao H, Wei L, Li H et al. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. Lancet Infect Dis 2021; 21: 847-57. 10.1016/S1473-3099(20)30596-X
European commission. EU Guideline for the Prudent Use of Antimicrobials in Human Health. European Commission, 2017. https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52017XC0701(01).
Essilini A, Pierre A, Bocquier A et al. Community pharmacists' views on their current role and future opportunities for antibiotic stewardship: a French qualitative study. JAC Antimicrob Resist 2021; 3: dlab129. 10.1093/jacamr/dlab129
Lambert M, Smit CCH, De Vos S et al. A systematic literature review and meta-analysis of community pharmacist-led interventions to optimise the use of antibiotics. Br J Clin Pharmacol 2022; 88: 2617-41. 10.1111/bcp.15254
Higgs J, Jensen GM, Loftus S et al. Clinical Reasoning in the Health Professions - 4th Edition. 4th edn. Elsevier, 2018. https://shop.elsevier.com/books/clinical-reasoning-in-the-health-professions/higgs/978-0-7020-6224-7.
Nusair MB, Cor MK, Roduta Roberts M et al. Community pharmacists' clinical reasoning: a protocol analysis. Int J Clin Pharm 2019; 41: 1471-82. 10.1007/s11096-019-00906-3
Haider I, Luetsch K. Pharmacists' advice and clinical reasoning in relation to cardiovascular disease risk factors - a vignette case study. Res Soc Adm Pharm 2020; 16: 568-73. 10.1016/j.sapharm.2019.08.006
Croft H, Gilligan C, Rasiah R et al. Thinking in pharmacy practice: a study of community pharmacists' clinical reasoning in medication supply using the think-aloud method. Pharmacy 2018; 6: 1. 10.3390/pharmacy6010001
Akhtar S, Rutter P. Pharmacists thought processes in making a differential diagnosis using a gastro-intestinal case vignette. Res Soc Adm Pharm 2015; 11: 472-9. 10.1016/j.sapharm.2014.09.003
Gregory PAM, Whyte B, Austin Z. How do community pharmacists make decisions? Results of an exploratory qualitative study in Ontario. Can Pharm J Rev Pharm Can 2016; 149: 90-8. 10.1177/1715163515625656
Pelaccia T, Sherbino J, Wyer P et al. Diagnostic reasoning and cognitive error in emergency medicine: implications for teaching and learning. Acad Emerg Med 2025; 32: 320-6. 10.1111/acem.14968
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349-57. 10.1093/intqhc/mzm042
Miles MB, Huberman AM. Analyse des données qualitatives. De Boeck Supérieur, 2003.
Mertens JF, Koster ES, Deneer VHM et al. Factors influencing pharmacists' clinical decision making in pharmacy practice. Res Soc Adm Pharm 2023; 19: 1267-77. 10.1016/j.sapharm.2023.05.009
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6: 42. 10.1186/1748-5908-6-42
Légifrance. Arrêté du 17 juin 2024 fixant les modalités de délivrance de médicaments sans ordonnance après la réalisation d'un test rapide d'orientation diagnostique, les modalités de formation spécifique des pharmaciens d'officine en la matière et précisant les conditions de recours à une ordonnance de dispensation conditionnelle. https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000049734400.
Légifrance. Décret n° 2024-550 du 17 juin 2024 relatif à la délivrance sans ordonnance de certains médicaments, après réalisation d'un test rapide d'orientation diagnostique par les pharmaciens d'officine. 2024-550 2024.
Katada Y, Yonezawa A, Utsumi M et al. Pharmacist-physician collaborative care for outpatients with left ventricular assist devices using a cloud-based home medical management information-sharing system: a case report. J Pharm Health Care Sci 2021; 7: 5. 10.1186/s40780-020-00188-2
Schmid S, Schlosser S, Gülow K et al. Interprofessional collaboration between ICU physicians, staff nurses, and hospital pharmacists optimizes antimicrobial treatment and improves quality of care and economic outcome. Antibiot Basel Switz 2022; 11: 381. 10.3390/antibiotics11030381
Reeves S, Pelone F, Harrison R et al. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev 2018; 2018: CD000072. 10.1002/14651858.CD000072.pub3
