Praxis of antibiotic dispensing in the city of Zagreb and stances of pharmacists on antibiotic resistance: a qualitative study

Cilj istraživanja. Cilj istraživanja bio je stjecanje uvida u obrasce izdavanja i korištenja antibiotika za liječenje infekcija gornjeg dišnog sustava iz perspektive ljekarnika u gradu Zagrebu. Ispitanici i metode. Kvalitativno istraživanje provedeno je u razdoblju u razdoblju od studenog 2016. do ožujka 2017. godine i obuhvatilo je 10 ljekarnika (devet ljekarnica i jedan ljekarnik), zaposlenih u privatnim i gradskim javnim ljekarnama na području grada Zagreba, u rasponu dobi od 25 do 56 godine i s radnim iskustvom od šest mjeseci do 33 godina. Uključni kriteriji bili su 1) dobrovoljnost sudionika, 2) izdavanje antibiotika za infekciju gornjeg dišnog sustava u posljednjih tjedan dana od dana intervjuiranja te 3) potpisan Informirani pristanak. Sudionici istraživanja su u formi intervjua problematizirali obrasce korištenja antibiotika prema unaprijed pripremljenom scenariju pitanja. Izbor mjesta i vremena provedbe intervjua prilagođavano je sudionicima istraživanja. Dobiveni podaci su analizirani grupno uz izostanak bilo kakvih osobnih podataka sudionika. Primijenjena metoda obrade podataka je postupak otvorenog kodiranja prema Mesecu (1998). Povjerenstvo za etičnost eksperimentalnog rada Farmaceutsko-biokemijskog fakulteta u Zagrebu odobrilo je provedbu ovog istraživanja. Rezultati. Podijeljeni u pet kategorija kojim ljekarnici objašnjavaju postojeću praksu izdavanja antibiotika u gradu Zagrebu: opis prakse izdavanja antibiotika, povećana pravilna uporaba antibiotika – „Idemo, zapravo, tragom pravilne primjene“, zahtjevi pacijenata za izdavanjem AB bez recepta koji su i dalje prisutni ali u manjoj mjeri nego u prošlosti, percipirana prisutnost rezistencije, prijedlozi za unaprjeđenje učinkovitije uporabe AB koji su uglavnom edukacijske naravi. Zaključak. Učestalost pravilne uporabe AB u gradu Zagrebu je povećana zbog povećane svjesnosti ljekarnika, liječnika i pacijenata. Nasuprot tome, smanjena je učestalost potražnje AB bez recepta od strane pacijenata. Općenito, vidljiv je sveukupni napredak u području racionalne primjene AB te kako bi se ona nastavila osnaživati i unaprijeđivati potrebno je educirati kako širu javnost koja AB koristi, tako i liječnike koji ih propisuju te ljekarnike koji ih izdaju.Objectives. The aim of this study was to get a better insight into the patterns of dispensing process and use of antibiotics for the treatment of upper respiratory tract infections in the city of Zagreb, all of it from the perspective of a pharmacists. Patients and methods. A qualitative research was conducted in the period from the November 2016 to March 2017 and it included 10 pharmacists employed in private or public pharmacies in the Zagreb area, aged from 25 to 56 years, with a working experience of six months to 33 years. Inclusive criteria were 1) volunteer attendance, 2) dispensing antibiotics for upper respiratory tract infection during 7 days of the day of the interview, and 3) informed consent. Interview participants were questioned about the patterns of antibiotic use according to the pre-prepared scenario of the questions. The choice of place and time of interviewing was tailored to the participants of the research. The data obtained was analyzed in group without any personal data of the participant. The applied data processing method is the open encoding process according to Mesec (1998). The Ethics Committee of the Faculty of Pharmacy and Biochemistry in Zagreb approved the implementation of this research. Results. Results are divided into five categories by which pharmacists explain the existing practice of antibiotic labeling in the city of Zagreb: a description of the practice of antibiotic use, increased rational use of antibiotics - "We are heading towards trace of proper use of AB", patients requirements for AB without prescription still present but in a smaller amount than in the past, the perceived presence of antibiotic resistance, suggestions for practice improving and the more efficient use of AB: mainly of an educational charachter. Conclusion. The frequency of proper use of AB in the city of Zagreb has been increased due to increased awareness of pharmacists, doctors and patients. In contrast, the frequency of pursuing AB without prescription by patients was reduced. Furthermore, overall progress has been made in the area of rational use of AB, and in order to continue empowering and improving, it is necessary to educate the general public that uses AB, as well as doctors who prescribe AB and the pharmacists who dispense AB