International Journal of Clinical Pharmacy

, Volume 39, Issue 1, pp 61–69 | Cite as

Assessing pharmacists’ readiness to prescribe oral antibiotics for limited infections using a case-vignette technique

  • Elizabeth Ung
  • Petra Czarniak
  • Bruce Sunderland
  • Richard Parsons
  • Kreshnik HotiEmail author
Research Article


Background Pharmacist’s skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents’ level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.


Australia Case-vignettes Community pharmacies Limited infections Oral antibiotics Pharmacist prescribing Pharmacists 



Authors wish to thank pharmacists who participated in this study.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflicts of interest

The author(s) declare(s) that they have no conflict of interest.


  1. 1.
    Emmerton L, Marriott J, Bessell T, Nissen L, Dean L. Pharmacists and prescribing rights: review of international developments. J Pharm Pharm Sci. 2005;8(2):217–25.PubMedGoogle Scholar
  2. 2.
    Barry A. Media release—milestone for pharmacists. Pharmacy Council of New Zealand; 2013. Accessed 25 Sep 2016.
  3. 3.
    Courtenay M, Carey N, Stenner K. An overview of non medical prescribing across one strategic health authority: a questionnaire survey. BMC Health Serv Res. 2012;12:138.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Baqir W, Miller D, Richardson G. A brief history of pharmacist prescribing in the UK. Eur J Hosp Pharm. 2012;19(5):487–8.CrossRefGoogle Scholar
  5. 5.
    Commonwealth of Australia. Prescribing medicines—information for PBS prescribers. Canberra: Department of Health; 2014. Accessed 25 Sep 2016.
  6. 6.
    Nissen L, Kyle G. Non-medical prescribing in Australia. Aust Prescr. 2010;33(6):166–7.CrossRefGoogle Scholar
  7. 7.
    Haggan M. Community pharmacy to fight for expanded role. AJP; 2015. Accessed 25 Sep 2016.
  8. 8.
    The Pharmaceutical Society of Australia. Guidelines for the continued dispensing of eligible prescribed medicines by pharmacist. Canberra: Pharmaceutical Society of Australia; 2012. Accessed 11 Oct 2016.
  9. 9.
    The Pharmaceutical Society of Australia. Guidance for provision of a pharmacist only medicine: Famciclovir. Canberra: Pharmaceutical Society of Australia; 2014. Accessed 11 Oct 2016.
  10. 10.
    The Pharmaceutical Society of Australia. Guidance for provision of a pharmacist only medicine: Fluconazole. Canberra: Pharmaceutical Society of Australia; 2014. Accessed 11 Oct 2016.
  11. 11.
    The Pharmaceutical Society of Australia. Provision of chloramphenicol for ophthalmic use as a pharmacist only medicine. Canberra: Pharmaceutical Society of Australia; 2014. Accessed 11 Oct 2016.
  12. 12.
    The Pharmaceutical Society of Australia. Immunisation roundup: state and territories; 2015. Accessed 25 Sep 2016.
  13. 13.
    Fifth Community Pharmacy Agreement & The Pharmacy Guild of Australia. Medication management initiatives; 2014. Accessed 25 Sep 2016.
  14. 14.
    Daniels A. Forging team health-creating a new game. Aust Pharm. 2015;34(8):30.Google Scholar
  15. 15.
    Health Workforce Australia. Health professionals prescribing pathway (HPPP) project-final report; 2013. Accessed 11 Oct 2016.
  16. 16.
    The Pharmacy Guild of Australia. Community pharmacy roadmap program development template Australia. The pharmacy guild of Australia; 2014.—the-guild/Strategic-Direction/pharmacist-prescribing.pdf. Accessed 25 Sep 2016.
  17. 17.
    Keast K. Australia’s first allied health prescribing training. Health times; 2014. Accessed 25 Sep 2016.
  18. 18.
    Hoti K, Hughes J, Sunderland B. Identifying the perceived training needs for Australian pharmacist prescribers. Int J Pharm Pract. 2014;22(1):38–46.CrossRefPubMedGoogle Scholar
  19. 19.
    Department of Health. Improving patients’ access to medicines: a guide to implementing nurse and pharmacist independent prescribing within the NHS in England 2006. London: Department of Health; 2006. Accessed 25 Sep 2016.
  20. 20.
    Department of Health. Nurse and pharmacist independent prescribing changes annouced; 2012. Accessed 11 Jun 2016.
  21. 21.
    Zayegh I, Charrois TL, Hughes J, Hoti K. Antibiotic repeat prescriptions: are patients not-refilling them properly? J Pharm Policy Pract. 2014;7(1):17.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Duckett S, Breadon P, Ginnivan L. Access all areas: new solutions for GP shortages in rural Australia. Melbourne: Grattan Institute; 2013.Google Scholar
  23. 23.
    Bessell T, Marriot J, Emmerton L, Nissen L. Improving Australians’ access to prescription medicines: development of pharmacy practice models (final report). Australia: Pharmacy Guild of Australia; 2005.—third-agreement/2003-017. Accessed 25 Sep 2016.
  24. 24.
    Silmalis L. Pharmacists given green light to give flu jabs on the spot instead of doctors or nurses. The Daily Telegraph; 2015. Accessed 25 Sept 2016.
  25. 25.
    Charrois T, Rosenthal M, Hoti K, Hughes C. Pharmacy student perceptions of pharmacist prescribing: a comparison study. Pharmacy. 2013;1(2):237–347.CrossRefGoogle Scholar
  26. 26.
    Hoti K, Hughes J, Sunderland B. Expanded prescribing: a comparison of the views of Australian hospital and community pharmacists. Int J Clin Pharm. 2013;35(3):469–75.CrossRefPubMedGoogle Scholar
  27. 27.
    Hoti K, Hughes K, Sunderland B. Pharmacy client’s attitudes to expanded pharmacist prescribing and the role of agency theory on involved stakeholders. Int J Pharm Pract. 2011;19(1):5–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Hoti K, Sunderland B, Hughes J, Parsons R. An evaluation of Australian pharmacist’s attitudes on expanding their prescribing role. Pharm World Sci. 2010;32(5):610–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Vracar D, Bajorek BV. Australian general practitioners’ views on pharmacist prescribing. J Pharm Pract Res. 2008;38(2):96–102.CrossRefGoogle Scholar
  30. 30.
    Kay OC, Bajorek VB, Brien JE. Pharmacist prescribing activities—an electronic survey on the opinions of Australian pharmacists. J Pharm Pract Res. 2006;36(3):199–203.CrossRefGoogle Scholar
  31. 31.
    Hoti K, Hughes J, Sunderland B. An expanded prescribing role for pharmacists—an Australian perspective. Aust Med J. 2011;4(4):236–42.CrossRefGoogle Scholar
  32. 32.
    Res R, Hoti K, Charrois TL. Pharmacists’ perceptions regarding optimization of antibiotic prescribing in the community. J Pharm Pract. 2016; pii:0897190015623883 [Epup ahead of print].Google Scholar
  33. 33.
    Alkhatib L, Parsons R, Czarniak P, Sunderland VB. An evaluation of the reclassification of ophthalmic chloramphenicol for the management of acute bacterial conjunctivitis in community pharmacies in Western Australia. Int J Pharm Pract. 2015;23(2):111–20.CrossRefPubMedGoogle Scholar
  34. 34.
    Boynton P, Greenhalgh T. Hands-on guide to questionnaire research—selecting, designing, and developing your questionnaire. BMJ. 2004;328(7451):1312–5.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Taylor BJ. Factorial surveys: using vignettes to study professional judgement. Br J Soc Work. 2006;36:1187–207.CrossRefGoogle Scholar
  36. 36.
    Spalding NJ, Phillips T. Exploring the use of vignettes: from validity to trustworthiness. Qual Health Res. 2007;17(7):954–62.CrossRefPubMedGoogle Scholar
  37. 37.
    Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines; 2014.Google Scholar
  38. 38.
    Pharmacy Registration Board of Western Australia. Premise register; 2015. Accessed 25 Sep 2016.

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Elizabeth Ung
    • 1
  • Petra Czarniak
    • 1
  • Bruce Sunderland
    • 1
  • Richard Parsons
    • 1
  • Kreshnik Hoti
    • 1
    • 2
    Email author
  1. 1.Curtin Health and Innovation Research Institute, School of PharmacyCurtin UniversityPerthAustralia
  2. 2.Pharmacy Department, Faculty of MedicineUniversity of PrishtinaPrishtinaKosovo

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