title: The path of least resistance? Jurisdictions, responsibility and professional asymmetries in pharmacists' accounts of antibiotic decisions in hospitals.
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.
authors.affiliation: School of Social Sciences, The University of New South Wales, Sydney, Australia. Electronic address: a.broom@unsw.edu.au.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.affiliation: Department of Medicine, Sunshine Coast Hospital and Health Service, Australia. Electronic address: jennifer.broom@health.qld.gov.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Broom
authors.affiliation: School of Social Sciences, The University of New South Wales, Sydney, Australia. Electronic address: emma.kirby@unsw.edu.au.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
authors.affiliation: Department of Sociology, University of Surrey, Guildford, United Kingdom. Electronic address: g.scambler@hotmail.com.
authors.forename: Graham
authors.initials: G
authors.lastname: Scambler
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001315:Australia; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D006801:Humans; D007400:Interprofessional Relations / Q000941:ethics*; D000069342:Medical Overuse / Q000517:prevention & control*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012962:Sociology, Medical
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Australia; Hospital; Pharmacy; Qualitative; Sociology