Eliciting lead antimicrobial pharmacists’ perspectives on oral antibacterial prescribing in primary care out-of-hours services in Wales: a qualitative interview study

Abstract Introduction Oral antibacterial prescribing is a key contributor to antimicrobial resistance.1 Understanding prescribing patterns and impact of antimicrobial stewardship (AMS) interventions is essential to promote rational use. This is particularly important in primary care out-of-hours (OOH) services (weekdays 18:30–08:00, weekends, and holidays), where antibacterial prescribing is common and evidence lacking.2 While previously collected quantitative data from Wales showed declining prescribing trends, deeper exploration can reveal broader context, underlying drivers, and opportunities to strengthen AMS. Aim To explore lead antimicrobial pharmacists’ perspectives on oral antibacterial prescribing in Wales primary care overall, focusing on OOH services. Methods A qualitative methodology was employed. Online semi-structured interviews were conducted with lead and/or primary care antimicrobial pharmacists, or equivalent professionals when suitable, from each Health Board (HB) in Wales (n = 7). Purposive sampling ensured inclusion of participants with relevant national and HB knowledge and expertise in antimicrobial prescribing and stewardship who could contextualise the quantitative prescribing trends shared with them. The interview schedule explored perspectives on prescribing patterns, influencing factors, available AMS interventions, and barriers and facilitators within OOH services. Participants were identified and contacted by a gatekeeper, and those who consented were interviewed. Interviews were audio- and video-recorded, transcribed verbatim, and analysed thematically. Results Seven interviews were conducted. Participants attributed declining prescribing to collective efforts toward national targets rather than specific interventions. They highlighted limitations in the presented data, noting factors to consider when comparing HBs (e.g. demographics, socioeconomic conditions), restricting their ability to elaborate on these trends. Five themes and fourteen subthemes were constructed (Table 1). Conclusion This study identifies multiple influences on oral antibacterial prescribing in primary care, including OOH services, highlighting challenges, opportunities for improvement, and limitations of OOH data. Although the sample was small, information power was considered adequate with one representative from each HB included as intended given participants’ oversight role. As shared data spanned several years, some participants lacked direct experience of earlier prescribing, which may have limited awareness of past influences. Nonetheless, the insights gained may help stakeholders enhance current systems, refine interventions, or develop strategies to support prescribers across healthcare settings.