Magnitude and determinants of antibiotic dispensing without prescription in Spain: a simulated patient study.

Objectives: Excessive and inappropriate use of antibiotics increases antimicrobial resistance. The aim of this study was to determine the magnitude and determinants of antibiotic dispensing without prescription in Spain by the simulated patient technique. Methods: A cross-sectional study was conducted with all the pharmacies in a region of north-west Spain (n = 977), between December 2016 and January 2017. Four actors visited the pharmacies simulating a respiratory infection. Four incremental levels of pressure were used to obtain an antibiotic. The education and sex of the person who was dispensing and the area where the pharmacy was located were recorded. The effect of these independent variables on the dispensing of an antibiotic without prescription (1 = yes, 0 = no) was modelled by logistic regression. Results: An antibiotic was obtained in 18.83% (95% CI = 16.5%-21.41%) of the visits. The area influenced the dispensing of antibiotics without a medical prescription, with a greater likelihood of dispensing in rural (OR = 1.79; 95% CI = 1.20-2.68) or semi-rural (OR = 1.66; 95% CI = 1.13-2.44) areas than in urban areas. No association was found with the sex or the training of the person who dispensed the antibiotic. In the pharmacies in urban areas, a lower level of pressure was needed to obtain the antibiotic. Conclusions: This study shows that one-fifth of the pharmacies still dispense antibiotics without prescription, especially under patient pressure. A rural setting has been identified as a risk factor for dispensing without prescription, so it must be taken into account for future interventions.

Selling antimicrobials without prescription - Far beyond an administrative problem.

INTRODUCTION: Selling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. MATERIAL AND METHODS: A prospective study was carried out in January 2013 - February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. RESULTS: The actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. CONCLUSION: It is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population.

Selling antimicrobials without prescription - Far beyond an administrative problem / La dispensación de antibióticos sin receta, mucho más que un problema administrativo

INTRODUCTION: Selling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. MATERIAL AND METHODS: A prospective study was carried out in January 2013 - February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. RESULTS: The actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. CONCLUSION: It is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population

INTRODUCCIÓN: La dispensación de antibióticos sin receta es un hecho habitual en nuestro país sin tener en cuenta el riesgo que supone para el paciente y la sociedad. El objetivo del estudio fue evaluar la información suministrada por el personal de la oficina de farmacia a una paciente simulada que pedía un antibiótico. MATERIAL Y MÉTODOS: Estudio prospectivo realizado en el período de enero de 2013 a febrero de 2014 en la Región Sanitaria de Tarragona (Cataluña), donde una compradora simulada visitó 220 farmacias pidiendo que se le vendiera un antibiótico. RESULTADOS: En un 73,9% de los casos no se preguntó por las alergias y en ninguno si estaba embarazada. En un 36,1% de los casos se recomendó ir al médico. Cuando no se vendió el antibiótico, la respuesta facilitada fue razonada solo en un 9,9% de los casos. CONCLUSIÓN: Es necesario y urgente mejorar la formación profesional de los farmacéuticos en la dispensación de antibióticos y también los conocimientos básicos de salud de la población