What drives inappropriate antibiotic dispensing? A mixed-methods study of pharmacy employee perspectives in Haryana, India

• Published in: BMJ open Vol. 7; no. 3; p. e013190
• Main Authors: Barker, Anna K, Brown, Kelli, Ahsan, Muneeb, Sengupta, Sharmila, Safdar, Nasia
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2017; BMJ Publishing Group
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Attitude of Health Personnel; Community Pharmacy Services; Cross-Sectional Studies; Drug Prescriptions; Drug resistance; Drug Resistance, Microbial; Drug stores; Education, Pharmacy; Employees; Female; Global Health; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; India; Interviews; Licensure; Low income groups; Male; Mixed methods research; Patients; Pharmacies; Pharmacists; Pharmacy; Physicians; Population; Poverty; Surveys and Questionnaires; United States > US; India; INFECTIOUS DISEASES; TROPICAL MEDICINE
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-013190

ObjectivesThere are only 0.70 licensed physicians per 1000 people in India. Thus, pharmacies are a primary source of healthcare and patients often seek their services directly, especially in village settings. However, there is wide variability in a pharmacy employee's training, which contributes to inappropriate antibiotic dispensing and misuse. These practices increase the risk of antibiotic resistance and poor patient outcomes. This study seeks to better understand the factors that drive inappropriate antibiotic dispensing among pharmacy employees in India's village communities.DesignWe conducted a mixed-methods study of the antibiotic dispensing practices, including semistructured interviews and a pilot cross-sectional Knowledge, Attitudes and Practice survey. All data were transcribed, translated from Hindi into English, and coded for themes.SettingCommunity pharmacies in villages in Haryana, India.ParticipantsWe recruited 24 community pharmacy employees (all male) by convenience sampling. Participants have a range of characteristics regarding village location, monthly income, baseline antibiotic knowledge, formal education and licensure.Results75% of pharmacy employees in our study were unlicensed practitioners, and the majority had very limited understanding of antibiotic resistance. Furthermore, only half could correctly define the term antibiotics. All reported that at times they dispensed antibiotics without a prescription. This practice was more common when treating patients who had limited access to a licensed physician because of economic or logistic reasons. Many pharmacy workers also felt pressure to provide shortened medication courses to poorer clientele, and often dispensed only 1 or 2 days' worth of antibiotics. Such patients rarely returned to the pharmacy for the complete course.ConclusionsThis study highlights the need for short-term, intensive training programmes on antibiotic prescribing and resistance that can be disseminated to village pharmacies. Programme development should take into account the realities of working with poor clientele, especially in areas of limited healthcare access.