Antibiotic Access and Use in the Community and the Feasibility to Implement Pharmacy Targeted Interventions

Nguyen, Nam Vinh (2023). Antibiotic Access and Use in the Community and the Feasibility to Implement Pharmacy Targeted Interventions. PhD thesis The Open University.



Over-consumption of antibiotics is a major concern globally and has been linked to the spread of antimicrobial resistance (AMR), which poses a challenge for healthcare systems across the world. However, despite international efforts to regulate antibiotic use, the global consumption of antibiotics has continued to increase over time, especially in low- and middle-income countries (LMICs) that are experiencing economic growth such as Vietnam. These countries are AMR hotspots and have experienced excessive consumption of antibiotics at different levels of the healthcare system. Antibiotic consumption in community settings dominates. Among these settings, community pharmacies, although not considered a formal provider for primary-care examination and treatment services, are known as a major contact for non-prescription supply of antibiotics, and a driver of their over-consumption.

My PhD was conducted with two main goals. The first goal was to obtain a comprehensive understanding of antibiotic use patterns in different types of healthcare settings at community-level in Vietnam. The second goal was to assess the feasibility of implementing pharmacy-targeted interventions to enhance rational antibiotic access and use in the community.

My PhD thesis includes six chapters:

- The first chapter provides an overview about antibiotics, antibiotic access and use at the community-level in LMICs and links to the spread of antimicrobial resistance. This chapter also summarizes antibiotic stewardship interventions that have been implemented at community-level, with a special focus on interventions targeting pharmacies and using point-of-care diagnostic tests.

- The second chapter provides the first look on antibiotic dispensing in the community. This chapter was based on a study using data from 1342 customer exit interviews at 20 community antibiotic suppliers in Ba Vi District, Hanoi in 2017 and 2018.

- The third chapter investigates antibiotic prescribing for acute respiratory infection (ARI) in primary healthcare settings. I retrospectively reviewed 193,010 health records of outpatients with ARI visiting one of 112 commune health centres in 6 rural districts of Nam Dinh province during 2019.

- The fourth and fifth chapters assess the feasibility of implementing an intervention aimed at reducing over-the-counter supply of antibiotics in pharmacies. The intervention was an out-of-pocket C-reactive-protein point-of-care testing (CRP-POCT) service to guide antibiotic treatment at private pharmacies for patients with minor ARI symptoms, the most common cause of healthcare seeking in the community. The fourth chapter was a quantitative study with participation of 520 pharmacy customers. This study investigated acceptability, willingness to pay for CRP-POCT, and the relevant determinants. The fifth chapter included a qualitative study to investigate different stakeholders’ perspectives. The participants were comprised of pharmacists, primary care doctors and medical specialists, health regulatory officials and device suppliers.

- The final (sixth) chapter of my thesis provides a comprehensive discussion of findings from the above chapters, their implications, limitations and recommendations in future studies.

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