Education on antimicrobial stewardship in community pharmacies to be delivered as a part of a public health campaign
Authors: Aggarwal R R , Barker A , Baggott C 
Published: November 2024

Abstract

Introduction
Community pharmacies are well-placed to educate the public on antimicrobial stewardship (AMS). Medicines management teams have historically focused on empowering prescribers to practise prudent use of antibiotics; in 2017 there was a lack of education/support to community pharmacy (CP) colleagues on the same topic, although subsequent ESPAUR reports (2) have highlighted the tools and resources that are now available to CP. To address the identified need locally, educational events for CP staff were organised with the aim of increasing knowledge of AMS and increasing confidence in recommending self-care for self-limiting respiratory tract infections (RTIs). Educational material delivered included key AMS messages, an introduction to the local antimicrobial guidelines and a case study.

Method
In the UK, a Birmingham based commissioning organisation organised a CP public health (PH) campaign promoting AMS. The campaign ran throughout February 2017. All CPs in Birmingham and Sandwell (n=385) were invited to an educational event, with 4 dates through January. The event provided educational presentations on AMS, including fundamentals of antimicrobial resistance (AMR), and management of self-limiting RTIs, with interactive case studies focussing on patients who may initially present to their local pharmacy. Content was delivered by a consultant microbiologist and the antimicrobial lead pharmacist. Learning outcomes included understanding of AMS, AMR, appropriate antibiotic use, and the role of a CP team in raising public awareness.
An electronic questionnaire was designed and provided to CP via PharmOutcomes after the campaign, to assess the impact of the events on the knowledge and confidence of the staff in delivering key AMS messages to the public. All responses were completed at the same time after the education session and this may impacted the results. The follow up questionnaire was classed as service evaluation by the organisation as per the NHS Health Research Authority assessment tool and did not require ethical approval.

Results
There were 226 responses to the questionnaire, from 210 (54.5%) CP. Of the 150 spaces available for the educational events, 144 tickets were reserved. Prior to the session 26% (n/58) of CP staff felt their knowledge of AMS was very good or excellent; after the session this increased to 78% (n/177). Confidence in recommending self-care for self-limiting RTIs also increased, with 79.2% (n/179) rating their confidence as very good or excellent after the session compared to 36.3% (n/82) beforehand. 95% (n/214) of CP staff felt that the education session changed their attitude towards AMS.

Discussion / Conclusion
This intervention showed a positive outcome of increasing CP knowledge about AMS and confidence in recommending appropriate self-care. The educational events were well attended although not all pharmacies were able to engage with the events and not all the learning outcomes were able to be captured in the evaluation survey.
Overall feedback from CP was positive with the majority of staff gaining an increase knowledge and confidence in communicating with the public and recommending self care where appropriate.
As the questionnaire was anonymised, we were unable to follow up feedback from individuals, which have useful to inform future sessions.

References
1. NHS Business Services Authority. Pharmacy Quality Scheme (PQS) 2023/24. https://www.nhsbsa.nhs.uk/provider-assurance-pharmaceutical-services/pharmacy-quality-scheme-pqs (18/04/24, date last accessed).
2. UKHSA English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2023. Accessed. Available at https://assets.publishing.service.gov.uk/media/65cf498ee1bdec001132225c/ESPAUR-report-2022-to-2023.pdf