Factors associated with inappropriate dispensing of antibiotics among non-pharmacist pharmacy workers

Background: Pharmacies are a primary source of healthcare services in low and middle income countries, especially where patient to physician ratio is low. Due to the wide variability in the training of pharmacy workers, inappropriate antibiotic dispensing is common, which increases the risk of poor therapeutic outcomes and antibiotic resistance. Objectives: This study aims to understand the factors that drive the inappropriate dispensing of antibiotics among pharmacy workers in Bahawalpur, Pakistan. Methods: In this qualitative study, the data were collected from the pharmacy workers through semi-structured interviews. A two-step sampling procedure, including purposive and convenient sampling techniques, was adopted to recruit the study participants. The sample size was determined by applying the saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analysed to draw conclusions using the inductive thematic analysis approach. Results: A total of 16 in-depth interviews were conducted. Data analysis yielded four themes and 18 subthemes. Under-dispensing and dispensing of antibiotics without need were reported. Lack of knowledge of dispensers, false feeling of being qualified, social acceptance, customer demands, public beliefs, high consultation fees of doctors, expensive diagnostic tests, economic influences and profit maximization were the main factors associated with the inappropriate dispensing of antibiotics. Conclusions: Multiple pharmacy worker (non-pharmacist) level factors that may lead to the inappropriate dispensing of antibiotics were identified in this study. There is a dire need for the training of pharmacy workers and supervision of their dispensing practices. Strict enforcement of legislation is required to restrict the irrational use of antibiotics in Pakistan.