Community pharmacists referrals to General Practice with suspected need of antibiotics - a national prospective pilot

BackgroundInterventions to minimise community antibiotic use have focused on the GP and patient behaviour rather than the community pharmacist. Patient expectations are a known driver for antibiotic prescribing, and pharmacists may be inveterately contributing to these expectations by referring patients for GPs for suspected antibiotic-requiring infections (S-ARI). We sought to quantify these referral rates. MethodPharmacists and GPs were recruited independently using convenience sampling and completed prospective data collection on 20 minor ailment encounters and consecutive consultations respectively. Pharmacists recorded patient gender, age, referral reason and comments (if any). GPs recorded patient age, gender, reason for visit, and origin of patient referral including self-referral. All data were analysed descriptively. Generalised estimating equations, multivariable logistic regression was used to investigate factors that may be associated with pharmacist referral rates. ResultsNineteen pharmacists representing 466 minor ailments encounters, and 19 GPs representing 394 consultations were recruited. Pharmacists referred 16.5% (77/466) of all minor ailments encounters for S-ARI. Comments suggested that reasons included upper-respiratory tract, ear nose and throat, and urinary tract infections. Most of S-ARI referrals were to a GP (62/466). None of the 88 consultations for infection in GP data were documented as being referred by a pharmacist; majority were self-referred (77.3%; 68/88). DiscussionPharmacists referred 1 in 8 minor ailments encounters to the GP for S-ARI, with some indication they were for conditions that do not require antibiotics. Most GP consultations for infection were documented as self-referrals. Both provide potential points of intervention to minimise antibiotic use.