Assessment of Community Pharmacists’ Knowledge, Attitude and Practice Regarding Non-Prescription Antimicrobial Use and Resistance in Thailand
Background: An estimated two-thirds of global sales of antimicrobials occur over the counter without a prescription. Furthermore, antimicrobials are the most commonly sold medicines in developing countries. The overuse, misuse, or inappropriate use of antimicrobials are major contributing factors to the emergence of antimicrobial resistance. This does not only lead to failure of therapy, increased morbidity and mortality, and rise in healthcare costs, but it puts these countries on a fast track to the pre-antibiotic era. Thailand is experiencing soaring antimicrobial resistance. A few studies suggest that inadequate knowledge, incorrect attitudes and malpractices of healthcare professionals and patients regarding the use of antimicrobials and reducing the emergence of antimicrobial resistance may be fuelling this crisis. Pharmacists in particular, may have a key role in rationalising the use of antimicrobials in community and reducing the emergence of resistance. Aim This study aims to assess pharmacists’ knowledge, attitudes and practices regarding antimicrobials use over the counter and antimicrobial resistance. Methods A cross-sectional descriptive study was conducted using online self-administered questionnaire for pharmacists in Bangkok and Chonburi province in Thailand between May and July 2017. The self-administered questionnaire was developed following a review the literature relating to pharmacists and healthcare professionals using the Knowledge, Attitude and Practices (KAP) model regarding antimicrobial use and resistance. The questionnaire was validated by an expert panel and its validity and reliability was tested in a pilot study. Statistic Package for the Social Science (SPSS) software version 24 was used for statistical analysis. The Cronbach’s alpha and Interclass correlation coefficients (ICC) were used to test of reliability. Kolmogorov-Smirnov Test was used for normal distribution testing. Descriptive data were examined by the median, interquartile range (IQR), Chi-squared test. Mann-Whitney U Test and Kruskal-Wallis test were used to describe associations between demographics with knowledge, attitude and practice of participants. Relationships between knowledge, attitude and practice dimensions were analysed by regression equations and Spearman’s correlation coefficient statistic. Qualitative data were coded and presented as percentages. Results 372 pharmacists completed the questionnaire obtaining a response rate of 71.4%. The community pharmacists age average was 32.02 (± 5.81) years. Most participants hold a bachelor degree in pharmacy (77.2%), and work at individual/ independent drug stores (62.6%). The average experience in community pharmacy is 5.46 (± 4.31) years. 69.4% of the participants work in Bangkok and 30.6% work in Chonburi. More than 90% of pharmacists have good knowledge, attitude and practice in antimicrobial use and resistance. However, there is only a slight correlation between attitude and practice score at rho = 0.149, p-value 0.004. The most commonly encountered infections are respiratory infections and Aminopenicillin is the main drug provided in pharmacies. The main reported reason of pharmacists to provide antimicrobials without a prescription was their confidence in their competency. Conclusion Respiratory infections were the most commonly encountered infections in community in Thailand, with Aminopenicillin being the most commonly dispensed antibiotic. Community pharmacists in Thailand report competence as the main reason for them providing antimicrobials without a prescription. This study shows that over 90% of them have good knowledge, attitude, and practice regarding antimicrobial use and resistance. Pharmacists in Thailand could sustain their competence through continuing education, adherence to antimicrobials guidelines, collaboration with other healthcare providers, and raising public awareness regarding antimicrobial use and resistance. Pharmacy associations could support pharmacists to improve pharmacy services through research, training, campaigning, professional standards and guidelines, and increasing inter-professional collaboration in fighting antimicrobial resistance. Further, government and policy makers could enhance pharmacists’ role in ensuring the appropriate use of antimicrobial and combatting antimicrobial resistance through the provision of national databases and surveillance programmes, research funding and healthcare regulations.