The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation

Ferdiana, Astri and Mashuri, Yusuf Ari and Wulandari, Luh Putu Lila and Rahayu, Ihsanti Dwi and Hasanah, Miratul and Ayuningsih, Zulfa and Batura, Neha and Khan, Mishal and Liverani, Marco and Guy, Rebecca and Schierhout, Gill and Kaldor, John and Law, Matthew and Day, Richard and Jan, Stephen and Wibawa, Tri and Probandari, Ari and Yeung, Shunmay and Wiseman, Virginia (2024) The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation. BMJ Global Health, 9 (10): e015620. ISSN 20597908

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Abstract

Introduction Non-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia. Methods A pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ 2 tests and multivariate random-effects logistic regression models were conducted. Thirty in-depth interviews were conducted with pharmacists, staff and owners as well as other relevant stakeholders to understand any persistent barriers to prescription-based dispensing of antibiotics. Findings Eighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4) consultations in the participating group compared with 469/570 (82.3) in the non-participating group (p value <0.001). The pre-post difference in the non-prescription antibiotic dispensing rate in the participating group was 20.9 (76.3-55.4) compared with 2.3 (84.6-82.3) in the non-participating group (p value <0.001). Non-prescription antibiotics were less likely to be dispensed in the participating group (OR=0.19 (95 CI 0.09 to 0.43)) and more likely to be dispensed for the UTI scenario (OR=3.29 (95 CI 1.56 to 6.94)). Barriers to prescription-based antibiotic dispensing included fear of losing customers, customer demand, and no supervising pharmacist present. Interpretation Multifaceted interventions targeting community pharmacies can substantially reduce non-prescription antibiotic dispensing. Future studies to evaluate the implementation and sustainability of this intervention on a larger scale are needed. © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Item Type: Article
Additional Information: Cited by: 0; All Open Access, Gold Open Access, Green Open Access
Uncontrolled Keywords: antibiotic agent; non prescription drug; adult; antibiotic resistance; antimicrobial stewardship; Article; awareness; clinical laboratory; community pharmacist; consultation; consumer; controlled study; diarrhea; female; general practitioner; human; Indonesia; major clinical study; male; medical staff; middle income country; organization and management; outcome assessment; peer review; pharmacist; pharmacy (shop); prescription; private practice; quasi experimental study; regression model; univariate analysis; upper respiratory tract infection; urban population; urinary tract infection
Subjects: R Medicine > RM Therapeutics. Pharmacology
Divisions: Faculty of Medicine, Public Health and Nursing > Biomedical Sciences
Depositing User: Ani PURWANDARI
Date Deposited: 22 Apr 2025 07:15
Last Modified: 22 Apr 2025 07:15
URI: https://ir.lib.ugm.ac.id/id/eprint/16107

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