The path of least resistance? Jurisdictions, responsibility and professional asymmetries in pharmacists' accounts of antibiotic decisions in hospitals. (December 2015)

• Record Type: Journal Article
• Authors: Broom, Alex; Broom, Jennifer; Kirby, Emma; Scambler, Graham
• Is Part Of: Social science & medicine. Volume 146(2015)
• Page Start: 95
• Page End: 103
• Publication Date: 2015-12
• Subjects: Australia -- Sociology -- Qualitative -- Pharmacy -- Hospital -- Antibiotics; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2015.10.037
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: The misuse of antibiotics has become a major public health problem given the global threat of multi-resistant organisms and an anticipated 'antimicrobial perfect storm' within the next few decades. Despite recent attempts by health service providers to optimise antibiotic usage, widespread inappropriate use of antibiotics continues in hospitals internationally. In this study, drawing on qualitative interviews with Australian pharmacists, we explore how they engage in antibiotic decisions in the hospital environment. We develop a sociological understanding of pharmacy as situated within evolving interprofessional power relations, inflected by an emerging milieu whereby antibiotic optimisation is organisationally desired but interprofessionally constrained. We argue that the case of antibiotics articulates important interprofessional asymmetries, positioning pharmacists as delimited negotiators within the context of medical prescribing power. We conclude that jurisdictional uncertainties, and the resultant interprofessional dynamics between pharmacy and medicine, are vital delimiting factors in the emerging role of pharmacists as 'antimicrobial stewards' in the hospital environment. Moreover, we argue that a nuanced understanding of the character of interprofessional negotiations is key to improving the use of antibiotics within and beyond the hospital. Highlights: Qualitative study of 19 hospital pharmacists' experiences of antibiotic decisions. Examines dilemmas around intervening vis-à-vis interprofessional conflicts. Illustrates role of interprofessional negotiations in improving antibiotic use. Shows that antibiotic use is an interprofessional rather than a medical problem.