Perceived impact of pharmacists’ interventions on rational use of antibiotics in hospitals in Kampala District

Abstract

Introduction: Antibiotic resistance (AMR) is a threat to global health. A major driving factor for AMR is irrational use of antibiotics in hospitals. Involvement of pharmacists in antimicrobial stewardship (AMS) programs in hospitals can potentially improve rational use of antibiotics and avert the emergence of resistance. In Uganda, little is known about the involvement of pharmacists in AMS in hospitals. Objectives: The objective of this study was to describe pharmacists’ involvement in hospital AMS in Kampala district as well as the barriers and facilitators to their involvement Methods: Phenomenological study design was employed to conduct 8 semi structured interviews among pharmacists and Medicine and Therapeutics Committee (MTC) chairpersons. Participants were from public and private not-for-profit hospitals in Kampala district. Analysis was conducted with QDA Miner 5.0 software, utilising the framework approach. Results: Pharmacists were reported to contribute to AMS through managerial, clinical and advisory roles as well as information dissemination. Pharmacists’ interventions were perceived to be impactful in improving antibiotic use for instance in reducing meropenem consumption. Their impact in hospital AMS was said to be limited by lack of capacity building in predicting antimicrobial resistance and then later on management. Participants also reported challenges of: knowledge gap, lack of locally based research to support AMS interventions and limited funding. Facilitators of pharmacists’ involvement in AMS included: presence of MTCs where pharmacists met with other health cadres through their secretarial office to discuss about AMS, as well as availability of intern pharmacists who reduce the work load, and laboratory services. Conclusion: Pharmacists contribute to hospital AMS but their impact is still limited. There is need for multidisciplinary training in AMS, more locally-based research, capacity building and strong national policy, more proactive pharmacists’ initiative, increased funding in AMS and empowering intern pharmacists to cover the human resource gap by performing clinical roles.