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Global health
Research
What drives inappropriate antibiotic dispensing? A mixed-methods study of pharmacy employee perspectives in Haryana, India
  1. Anna K Barker1,
  2. Kelli Brown1,
  3. Muneeb Ahsan2,
  4. Sharmila Sengupta3,
  5. Nasia Safdar4,5
  1. 1Department of Population Health Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
  2. 2Medanta Institute of Education and Research, Medanta the Medicity Hospital, Gurgaon, Haryana, India
  3. 3Department of Clinical Microbiology & Infection Control, Medanta the Medicity Hospital, Gurgaon, Haryana, India
  4. 4Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
  5. 5William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin, USA
  1. Correspondence to Dr Nasia Safdar; ns2{at}medicine.wisc.edu

Abstract

Objectives There are only 0.70 licensed physicians per 1000 people in India. Thus, pharmacies are a primary source of healthcare and patients often seek their services directly, especially in village settings. However, there is wide variability in a pharmacy employee's training, which contributes to inappropriate antibiotic dispensing and misuse. These practices increase the risk of antibiotic resistance and poor patient outcomes. This study seeks to better understand the factors that drive inappropriate antibiotic dispensing among pharmacy employees in India's village communities.

Design We conducted a mixed-methods study of the antibiotic dispensing practices, including semistructured interviews and a pilot cross-sectional Knowledge, Attitudes and Practice survey. All data were transcribed, translated from Hindi into English, and coded for themes.

Setting Community pharmacies in villages in Haryana, India.

Participants We recruited 24 community pharmacy employees (all male) by convenience sampling. Participants have a range of characteristics regarding village location, monthly income, baseline antibiotic knowledge, formal education and licensure.

Results 75% of pharmacy employees in our study were unlicensed practitioners, and the majority had very limited understanding of antibiotic resistance. Furthermore, only half could correctly define the term antibiotics. All reported that at times they dispensed antibiotics without a prescription. This practice was more common when treating patients who had limited access to a licensed physician because of economic or logistic reasons. Many pharmacy workers also felt pressure to provide shortened medication courses to poorer clientele, and often dispensed only 1 or 2 days' worth of antibiotics. Such patients rarely returned to the pharmacy for the complete course.

Conclusions This study highlights the need for short-term, intensive training programmes on antibiotic prescribing and resistance that can be disseminated to village pharmacies. Programme development should take into account the realities of working with poor clientele, especially in areas of limited healthcare access.

  • INFECTIOUS DISEASES
  • TROPICAL MEDICINE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013190

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    Footnotes

    • Contributors AKB drafted and edited the manuscript, and contributed to study conception, design, data acquisition and data analysis. KB and MA contributed to data collection, data analysis and critical manuscript editing. SS and NS contributed to the study design and critical manuscript editing. All authors read and approved the final version of this manuscript.

    • Funding The research presented was supported under NIH awards UL1TR000427 and TL1TR000429, the Indo-US Science and Technology Forum S. N. Bose Scholars Program, and a Graduate Student Award from the Global Health Institute at the University of Wisconsin, Madison.

    • Competing interests None declared.

    • Ethics approval The Institutional Review Board at Medanta the Medicity Hospital approved this study. The Institutional Review Board at the University of Wisconsin granted this study exemption from review.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.