Community pharmacists’ role in optimising antibiotic use: The HAPPY PATIENT project to improve dispensing practices in five EU countries

Abstract

Background: Community pharmacies can play a pivotal role in optimising the use of antibiotics through their dispensing practice. Aim: To evaluate the impact of a multifaceted intervention on community pharmacies' quality of antibiotic dispensing. Method: A prospective before-after study conducted according to the Audit Project Odense methodology in community pharmacies in France, Greece, Lithuania, Poland, and Spain. Pharmacy staff audited dispensing practices through a self-registry form before and after a multifaceted intervention, comprising feedback to participants on dispensing practice, communication training, and providing educational materials for patients. Dispensing of all oral antibiotics for five days in February 2022 and after interventions in February 2023 was registered. Data were analysed by country and overall using ten quality indicators, with Chi-square tests and Students' t-tests applied. Results: A total of 91 pharmacists registered 5.054 dispenses. There was an 18 % (p < 0.001) improvement in the mean number of safety checks performed and a 17 % (p < 0.001) reduction in the number of dispenses for which no safety checks were performed after the intervention. Pharmacists provided 17 % (p < 0.001) more advice to patients and reduced the dispenses for which no advice was provided by 35 % (p = 0.006). This came with a 44 % (p < 0.001) increase in inappropriate advice that was provided. Large differences between the countries were observed. For performing safety checks, a 13 % (p = 0.004) worsening was seen in Greece and a 72 % (p=<0.001) improvement in Spain. In France, treatment duration and dose were discussed with patients in 97 % and 98 % of the dispenses at baseline, respectively, without improvements after the intervention. In Spain, this was 66 % and 51 % at baseline, significantly improving to 80 % and 64 % after the intervention. Conclusion: Quality of antibiotic dispensing increased significantly, indicating that intervention is a promising strategy to improve antibiotic use, especially in countries with lower practice standards