Impact Assessment of an Educational Intervention Toward Rational Antibiotic Use Among Community Pharmacists in Nepal

Sajala Kafle,1 Nisha Jha,2 Pathiyil Ravi Shankar,3 Shital Bhandary,4 Subish Palaian5 1Department of Pharmacology, Patan Academy of Health Sciences, Lalitpur, Nepal; 2Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal; 3IMU Centre for Education, IMU University, Kuala Lumpur, Malaysia; 4Department of Community Health Sciences and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal; 5Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab EmiratesCorrespondence: Sajala Kafle, Department of Pharmacology, Patan Academy of Health Sciences, Lalitpur, Nepal, Email [email protected] Subish Palaian, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates, Email [email protected]: Educating community pharmacists (CPs) is an important step in promoting rational use of antibiotics. In this study, authors assessed the impact of an educational intervention on knowledge, attitude, and practice (KAP) related to rational antibiotic use among selected CPs in Kathmandu valley, Nepal and also obtained qualitative feedback.Methods: An educational intervention was conducted among 162 CPs. Antimicrobial resistance (AMR) and its causes, strategies to contain resistance and the role of community pharmacists in reducing AMR were discussed followed by problem solving exercises. Their KAP were assessed before (baseline), posttest (immediately after the intervention), and retention (2 weeks after the intervention) using a pre-validated tool. The quantitative data were analyzed using appropriate tests (p < 0.05). Semi-structured qualitative interviews were conducted after the follow-up, among six CPs to obtain their perspectives on the intervention and their role in combating AMR.Results: The majority (n = 118; 72.84%) had a “Diploma in Pharmacy” qualification. The median (IQR) knowledge scores were 9 (1), 9 (2), and 10 (0) during the pretest, post-test, and retention, respectively (maximum score 10), p < 0.001. The attitude score improved from 25 (5.25) pretest to 27 (5.25) posttest (maximum score 35), p < 0.001. The intervention also increased practice scores [25 (6)] pretest to [27 (6)] posttest, (maximum score 30) p < 0.001. Sixty-one CPs (37.6%) mentioned that patients had no time and budget to visit physicians, and 42 (25.92%) mentioned that CPs were competent to treat common infections. Total KAP scores improved significantly among different subgroups of respondents after the intervention. This was retained during follow-up. Participants perceived the intervention program to be useful. Heavy competition, the presence of many community pharmacies, and pharmacy shopping by patients were mentioned as challenges by CPs.Conclusion: A positive outcome on the KAP scores and positive feedback suggests the potential benefits of a future larger-scale educational intervention.Keywords: antimicrobials, antibiotics, educational intervention, Kathmandu Valley, Nepal, resistance