Experience with a clinical decision support system in community pharmacies to recommend narrow-spectrum...

Area of Science:

• Pharmacy Practice
• Antimicrobial Stewardship
• Public Health

Background:

• Antibiotic overuse fuels bacterial resistance and increases healthcare costs.
• Reducing unnecessary broad-spectrum antimicrobial (BSA) prescriptions is a public health priority.

Purpose of the Study:

• To assess the feasibility of a community pharmacy intervention aimed at decreasing BSA use for upper respiratory tract infections.
• To evaluate pharmacist-led patient interviews and decision support for appropriate antibiotic prescribing.

Main Methods:

• Pharmacists conducted guided interviews with patients prescribed BSAs for respiratory symptoms in rural community pharmacies.
• A clinical decision support system aided pharmacists in diagnosis and appropriateness of BSA therapy.
• Pharmacists sought patient consent to contact primary care providers (PCPs) for alternative therapy recommendations.

Main Results:

• 192 patients with BSA prescriptions for respiratory infections were included; 97% consented to symptom discussion.
• Only 7% of patients agreed to allow pharmacists to contact their PCP for therapy changes.
• PCPs were receptive to switching BSAs to first-line agents like amoxicillin upon contact.

Conclusions:

• Patient consent is a significant barrier to pharmacist-led interventions aimed at reducing BSA use.
• A successful community pharmacy intervention requires a method, possibly a collaborative practice protocol, that bypasses patient consent for drug substitution.
• Alternative strategies are needed to effectively reduce BSA prescribing in community settings.