Community pharmacists' referrals to General Practice with suspected need of antibiotics: an Australian cross-sectional pilot study.

Abstract

Background: Interventions to reduce antibiotic use focus on general practitioners (GPs) and patient behaviour, not pharmacists, who may inadvertently drive antibiotic expectations by referrals to GPs. No data are available on pharmacist referrals for suspected antibiotic-requiring infections. We conducted a feasibility pilot to provide data for robust sample size calculation and identify areas for further exploration.

Method: Pharmacists and GPs were recruited independently using convenience sampling. They completed prospective data collection on 20 consecutive minor ailment encounters and consultations respectively. Pharmacists recorded patient gender, age, referral reason, and any comments. GPs recorded patient age, gender, reason for visit, and origin of patient referral including self-referral. All data were analysed descriptively. Generalized estimating equation multivariable logistic regression was used to investigate factors that may be associated with pharmacist referral rates.

Results: We recruited 19 pharmacists representing 466 minor ailments encounters, and 19 GPs representing 394 consultations. Pharmacists referred 17% (77/466) of all minor ailments encounters for suspected antibiotic-requiring infections. Comments suggested reasons included upper-respiratory tract, ear nose and throat, and urinary tract infections. Most of suspected antibiotic-requiring infections referrals were to a GP (81%; 62/77). No GP consultations for infection (n = 88) were documented as being referred by a pharmacist; the majority were self-referred (77%; 68/88).

Discussion: Our pilot indicated that exploration of pharmacist referral for antibiotics is feasible and warranted. Future studies should quantify referral rates, reasons for referral, and observed differences between pharmacist and GP results. Our results should be used for the basis of a robust sample size calculation.