Barriers and facilitators to antimicrobial stewardship in community pharmacy: A systematic review

Background: Community pharmacists (CPs) are well-positioned to address the threat of antimicrobial resistance (AMR) by encouraging appropriate antimicrobial use. Understanding the individual and contextual determinants of CPs’ involvement in antimicrobial stewardship (AMS) helps select sustainable strategies. Our objective was to identify and classify the barriers and facilitators to CPs’ involvement in AMS. Methods: We conducted a systematic review of studies that evaluated the determinants of CP recommending, prescribing, or counselling on appropriate antibiotic use. We searched 5 databases (Ovid Medline, Embase, International Pharmaceutical Abstracts, PsycINFO, and Ebsco CINAHL) from inception to April 24, 2024, using search concepts of community pharmacy and AMS. Title and abstract, as well as full-text screening, were performed by 2 reviewers. Risk of bias was assessed using a modified Critical Appraisal Skills Programme tool. We extracted study details, with barriers and facilitators categorized according to the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Results: Of the 2429 studies screened, 40 were included. High-income countries constituted 26 studies while 14 were in low-middle-income countries. Nine evaluated a specific AMS initiative. Key barriers included lack of time to participate in AMS, lack of collaboration with physicians, and lack of access to patient records. Facilitators included financial incentives and reimbursement for service, specialized training opportunities, and guidelines for AMS practice. Conclusion: This review identified key barriers and facilitators to antimicrobial stewardship in community pharmacy. These determinants can form the basis for selecting impactful community pharmacy AMS strategies to reduce the burden of AMR.