The Pharmacy Quality Scheme (PQS) has incentivised antimicrobial stewardship (AMS) in community pharmacy in England, it is claimed. 

Researchers assessed data from TARGET leaflet antibiotic checklists for 213,105 prescriptions submitted by 8,374 community pharmacies. The number of checklists completed by each pharmacy varied from one to 181. Overall, 44 per cent of pharmacies surpassed the number required for the PQS domain for AMS. 

Pharmacy teams and patients fully completed 83 per cent of checklists, assessing, for example: dose (95 per cent of checklists); appropriateness (95 per cent); duration (94 per cent); allergies, risk factors and interactions (94 per cent); adherence to guidelines (89 per cent); and antibiotic use in the previous three months (81 per cent). 

Pharmacists contacted prescribers with 1.3 per cent of the TARGET checklists, most commonly querying the strength, dose, duration, quantity and formulation (30 per cent); allergy (9 per cent); recent antibiotic use (5 per cent); and antibiotic choice (5 per cent).

The prescriber changed the dose, formulation, directions, strength or duration for 34 per cent of the prescriptions and suggested an alternative antibiotic in a further 21 per cent of cases. Nevertheless, 17 per cent of pharmacy teams reported issues contacting a prescriber to discuss antibiotic prescriptions.

The authors suggest that “future research should monitor the continuation of activities and the wider impacts on primary care”. 

They conclude that the findings “add to the evidence that community pharmacy can play a vital role in AMS and support the NHS in England, and internationally, to tackle the significant threat of AMR to public health”.

Patient educational needs also highlighted

Analysis of the same study showed that the TARGET checklist improves uptake of flu vaccinations and highlights “the vital  role that community pharmacy teams have in … educating the public” about antibiotics.

The 8,374 community pharmacies provided 69,861 leaflets to patients about their condition and treatment. Amoxicillin was the most commonly prescribed antibiotic (35 per cent of submissions), followed by nitrofurantoin (14 per cent), flucloxacillin (11 per cent), doxycycline (9 per cent) and metronidazole (7 per cent).

Many patients did not understand their antibiotic’s side-effects (16.6 per cent), how to take their antibiotics with food (15.5 per cent) and how long their symptoms would last (15.5 per cent). 

Other needs for further information included: why they must follow a healthcare professional’s instructions (4.2 per cent); why they must never share or keep their antibiotics for later use (5.8 per cent); and when to seek further help with their infection (7.0 per cent). Community pharmacy teams discussed antibiotic resistance with less than half of patients (42 per cent of checklists).

Of the submitted checklists, 47 per cent confirmed that patients had received the influenza vaccination (rising to 76 per cent of those entitled to free vaccination). Based on the antibiotic checklist, community pharmacies vaccinated a further 16,625 people (or 8 per cent of the submitted checklists).