Attitudes Towards using Clinical Decision Support in Community Pharmacies to Promote Antibiotic Stewardship

Abstract Background Outpatient antibiotic prescriptions drive antibiotic overuse in humans and the Centers for Disease Control and Prevention have identified pharmacies as a possible partner in outpatient stewardship efforts. Clinical decision support (CDS) tools can potentially be used at community pharmacies to aid in outpatient stewardship efforts. Objectives We sought to determine community pharmacist attitudes towards using a computerized CDS tool to evaluate and manage common complaints to then promote appropriate antibiotic prescribing. Methods We conducted in-depth semi-structured interviews of community pharmacists to determine attitudes towards using CDS tools in their practice and identify potential barriers in implementation. Thematic analysis was used to identify common themes and subthemes in pharmacist responses. Results We interviewed 21 pharmacists and identified five themes and 14 subthemes in our interviews. Pharmacists reported that patients frequently presented with acute infectious complaints and were universally supportive of a CDS intervention that would allow them to assess such patients and in turn, guide appropriate antibiotic prescribing. They noted that communication difficulties with prescribing physicians and lack of information sharing currently made it difficult to implement stewardship interventions and were interested in any intervention that could help overcome these barriers. Conclusion Community pharmacies represent an important point of contact for patients and are a potentially valuable setting for outpatient stewardship interventions. Pharmacists were overwhelmingly supportive of using CDS tools to evaluate patients and promote antimicrobial stewardship. These results suggest that it would be feasible to pilot such an intervention in the community pharmacy setting.