Impact of pharmacist-prescriber partnerships to track antibiotic prescribing in publicly funded primary care in the Cape Town metropole, South Africa: An implementation study

Background. More than 80% of the South African (SA) population receive their care in publicly funded primary care clinics. The majority come from socioeconomically disadvantaged communities, and bear the greatest burden from infectious diseases. However, there are very limited published data on and evaluation of antibiotic prescribing linked to clinical indication. This is a major gap. Objectives. To assess the impact of a pharmacist-prescriber partnership to track antibiotic prescribing in publicly funded primary healthcare clinics in the Cape Town metropole, SA. Methods. We conducted a prospective observational study across five clinics where there was a dispensing pharmacist team. At each clinic, a prescriber-pharmacist team gathered prospective antibiotic prescribing data for ‘acute cough’, linked to clinical indication, and provided individual prescribing feedback through each clinic’s WhatsApp messaging platform about their prescribing quality (antibiotic dose, duration, frequency). Results. Eight out of every 10 patients (adults and children) were prescribed an antibiotic (n=457). In a third of patients, an antibiotic was prescribed for suspected ‘community-acquired pneumonia’. The WhatsApp prescribing feedback was used in half of all visits. The proportion of pharmacy-dispensed antibiotics concordant with local guidelines in terms of prescribing quality was 95% (95% confidence interval 0.93 - 0.98), n=239). Against AWaRe (access/watch/reserve) guidance, 97% of antibiotics prescribed belonged to the ‘access’ group. Conclusion. Although prescribing concordance with guidelines was good, a significant proportion of patients were prescribed an antibiotic for ‘acute cough’. Our findings have filled a fundamental gap in the evidence base that will inform antibiotic stewardship innovations, guideline development and future interventions.