Deferred prescribing in practice: an observational study in community pharmacies in France during 2024-5 and feedback from pharmacists.

Abstract

Excessive use of antibiotics promotes antibiotic resistance. Deferred prescribing (prescriptions dispensed according to clinical progress) is a strategy to reduce this overconsumption. Recognized in some countries, this practice is poorly documented and not recommended in France. To determine the rate of deferred outpatient prescriptions, their dispensing rate, and their characteristics. This observational study was conducted over 1 year in 20 pharmacies and focused on prescriptions with a handwritten note indicating deferred dispensing. The data collected included patient age and sex, prescriber specialty, drug class, dispensing delay, and population density. Feedback from pharmacists was also collected. Of 174 deferred prescriptions (0.021% of prescriptions), 38% were dispensed immediately, 20% were dispensed later, and 42% were not dispensed. The majority were prescribed by general practitioners (84%). Dispensing was significantly more immediate in urban areas (P = 0.02). Feedback analysis showed that pharmacists had a positive perception of deferred prescribing, seeing it as a tool for empowerment, antibiotic reduction, and collaboration. However, its implementation was limited by logistical constraints and patients' perception of the prescription as a right to dispensing. Effectiveness of deferred prescribing in reducing antibiotic consumption appears to be limited, especially in urban areas. Deferred prescription has little effect on antibiotic consumption. It seems more important to learn not to prescribe antibiotics when infections are viral. Delaying the prescription may help, but communication between pharmacists, doctors, and patients needs to be strengthened. Harmonization of practices and patient education need to be improved in this context of cascading uncertainties.