Determining a future policy focus to support antimicrobial stewardship in community pharmacy: A modified Delphi study.

Background: Over the past decade, the pharmacy sector's policy, academic and professional spheres have increasingly drawn attention to the opportunities to better leverage the untapped potential of the community pharmacy sector in contributing to global efforts to reduce antimicrobial resistance (AMR). While efforts are in train, progress is slow. Objective: To draw insights from global experts in the field to identify a broad range of potential future policy directions to support community pharmacists' involvement in antimicrobial stewardship (AMS). Methods: A modified Delphi technique, comprising two survey rounds to build consensus amongst global community pharmacy sector stakeholders and opinion leaders. In Round 1, participants rated their level of agreement with 28 statements across the three domains of policy design, implementation design, and monitoring and evaluation. Participants were also invited to contribute feedback in Round 1, which was reflected as new statements (n = 10) in Round 2. In Round 2, participants were asked to re-assess Round 1 statements in view of the group consensus and to rate the new statements. Results: 289 participants were invited to participate. 48/289 (17% response rate) completed Round 1, and 25/42 (60% response rate) completed Round 2. Consensus (defined as >70% agreement) was achieved for 79% (n = 30) of the statements across the three domains. Conclusion: Pharmacy sector experts agreed that acknowledging community pharmacists in AMS national action plans is an important component, signalling a recognition of the sector's contribution to whole-of-nation AMS efforts. Implementation components that achieved consensus reflect the profession's evolution to a professional service driven model, particularly in complementary AMS initiatives including infection prevention and control measures. Context-specific adjustments to support implementing these AMS measures will be required, in addition to striking the appropriate balance to support the pace of increased community pharmacists'involvement in AMS with building whole-of-profession buy-in.

Community pharmacists as antimicrobial guardians and gatekeepers - A qualitative study of the perspectives of pharmacy sector stakeholders.

Background: Community pharmacists, as primary care providers, are an underutilised resource in antimicrobial stewardship (AMS). Primary care plays an important role in tackling antimicrobial resistance (AMR) as the principle of balancing access to antimicrobials while ensuring optimal use is agnostic to health setting. Understanding the sector's perceptions and practices towards AMS involvement is a continuing focus area of research. However, there is an opportunity to understand the sociological factors which influence the profession's contribution to stewardship practice, particularly across a broader spectrum of sector stakeholders at the individual, practice, system, and policy levels. Objective: To explore stakeholders' perceptions of the Australian community pharmacy sector's AMS involvement. Methods: Semi-structured interviews were conducted with fifteen key informants from the Australian community pharmacy sector. Participants' insights were invited across three broad areas: (1) understanding of AMR and AMS; and the (2) current and (3) future state of community pharmacy's AMS involvement. Interviews were audio-recorded, transcribed verbatim and analyzed using a combined method of inductive (informed by the Theoretical Domains Framework) and deductive thematic analysis. Results: Perceptions on promoting community pharmacists' AMS involvement within their existing role in promoting the quality use of medicines were heard. Adopting an antimicrobial guardian or gatekeeper role was perceived as influenced by the timing of their interaction with a patient either prior to, or post-consultation with a general practitioner (GP). Suggestions that the profession's potential and actual role in AMS could be challenged or even delimited due to lack of access to completeness of clinical information, and perceived consequences from a clinical and professional engagement perspective were also heard. Conclusion: Collaborative partnerships between GPs and community pharmacists, framing stewardship within a quality use of medicines agenda, and highlighting connections between pharmacists' professional services such as minor ailments are key elements enabling community pharmacist's antimicrobial gatekeeper and guardian role.

Consumer perceptions of community pharmacists' involvement in antimicrobial stewardship: A quantitative study.

Background Community pharmacist involvement in antimicrobial stewardship (AMS) within primary care is underutilised. Despite this view being consistently held across the pharmacy sector's policy, academic and professional spheres, there is limited understanding of how this positioning aligns with consumers' perceptions and expectations. Objective To explore participants' experience using antibiotics and their engagement with pharmacists to support their use. Methods Online survey of Australian adults recruited via Dynata's research panel in November 2022. Questions were organised into three sections: 1) understanding the participant's use of antibiotics, including their information needs; 2) exploring engagement with pharmacists on a cold and flu enquiry using a vignette question; and 3) demographic information. Results Doctors (42.0%), pharmacists (29.8%) and the internet including general searches (14.3%) were the top three sources for antibiotic information. Information about side effects and anticipated time to effect were more broadly sought from pharmacists than what was provided. Over 50% of respondents indicated alignment between the best practice example of a pharmacist providing cold and flu management advice with their own experience. 17% of respondents indicated that they would seek doctor's advice when considering cold and flu management options compared to 10% seeking pharmacist's advice. No statistically significant results between age groups or gender were observed. Conclusion Better visibility of community pharmacists' involvement in managing minor ailments in primary care, including more explicit linkage of pharmacist-administered vaccination services as an AMS strategy can support optimal antimicrobial use.

Review of position statements on antimicrobial resistance and stewardship from professional pharmacy organisations.

INTRODUCTION: Pharmacists play a key role in tackling the global public health threat of antimicrobial resistance (AMR) through contributing to antimicrobial stewardship (AMS) practices. Professional pharmacy organisations describe this AMS role in position statements. Understanding how this role is described, including the why and potential impact is a first step to understanding how this issue is described to the profession, and framed in advocacy. OBJECTIVE: To examine how pharmacy's role in optimising antimicrobial use is articulated in pharmacy professional organisations' position statements. METHODS: Publicly available AMR position statements were sourced between February 2021 and May 2021 from the available websites of all International Pharmaceutical Federation (FIP) member organisations, supplemented by a general engine search. Descriptive analysis was conducted with a focus on four key themes of interest: 1) rationale for pharmacists' involvement in AMS) 2) characterisation of pharmacists' AMS role; 3) perceived impact of pharmacists' involvement in AMS; and 4) perceived enablers and/or barriers to AMS involvement. RESULTS: 17 position statements were sourced and analysed. Professional pharmacy organisations appear to focus on characterising pharmacists as advisors and educators as their primary role in AMS, with this function supported by their medication knowledge and accessibility as a health service. Specific settings, such as hospital or community pharmacy, were often highlighted in the documents, and were associated with the framing of the capacity and nature of pharmacists' involvement in AMS. However, the limitations of pharmacists and their positions were not discussed. CONCLUSIONS: There is an opportunity for future research to explore the concordance between the expectation of pharmacists' involvement in AMS as outlined in these position statements, with the reality of their involvement. This is of importance in the primary care setting, as a key access point to antimicrobials globally.

Exploring the representation of antimicrobial resistance and stewardship in Australian pharmacy media: a content analysis.

OBJECTIVES: Tackling the global health threat of antimicrobial resistance (AMR) requires a whole of system effort, which includes the involvement of pharmacists. However, the nature and extent of their current involvement may be shaped by content published in the media, including in professional publications. This study aimed to explore content inclusions relating to AMR and antimicrobial stewardship (AMS) in pharmacy focussed professional publications as a foundational step to understanding the impact of media content on pharmacists' behaviour relating to AMS. METHODS: A range of search terms were used to review the key professional publications targeting the Australian pharmacy sector, from the period 1 January 2014 to 30 June 2019. A content analysis was conducted using a coding framework that explored seven key themes of interest. KEY FINDINGS: Of the 488 articles reviewed, 251 were retained for analysis. Most publications featured excerpts of research publications and published reports. Clinicians' prescribing behaviour and the pharmaceutical industry's manufacturing and research and development practices were described as the main contributors to the development of AMR. The breadth of pharmacists' contribution to AMS was often segmented by place of practice, with few references to the positive links between pharmacists' current activities in preventing and controlling infections to reducing AMR. CONCLUSION: This study highlights that pharmacy-related media content is focused on raising awareness on the issue of AMR. There are opportunities, however, for increased coverage on pharmacists' contribution to AMS, particularly in the community setting. This includes highlighting linkages between existing pharmacy services, such as immunisation, to broader AMS efforts.

Exploring the use of entertainment-education YouTube videos focused on infection prevention and control.

BACKGROUND: As a communications strategy, education entertainment has been used to inform, influence, and shift societal and individual behaviors. Recently, there has been an increasing number of entertainment-education YouTube videos focused on hand hygiene. However, there is currently no understanding about the quality of these videos; therefore, this study aimed to explore the social media content and user engagement with these videos. METHODS: The search terms "hand hygiene" and "hand hygiene education" were used to query YouTube. Video content had to be directed at a health care professional audience. Using author designed checklists, each video was systematically evaluated and grouped according to educational usefulness and was subsequently evaluated against the categories of attractiveness, comprehension, and persuasiveness. RESULTS: A total of 400 videos were screened, with 70 videos retained for analysis. Of these, 55.7% (n = 39) were categorized as educationally useful. Overall, educationally useful videos scored higher than noneducationally useful videos across the categories of attractiveness, comprehension, and persuasiveness. Miscommunication of the concept of My 5 Moments for Hand Hygiene was observed in several of the YouTube videos. CONCLUSIONS: The availability of educationally useful videos in relation to hand hygiene is evident; however, it is clear that there are opportunities for contributors using this medium to strengthen their alignment with social media best practice principles to maximize the effectiveness, reach, and sustainability of their content.