The use of opioids at the end of life: knowledge level of pharmacists and cooperation with physicians

Community Pharmacists' Knowledge and Attitude Towards Opioid Pain Medication Use in Bahir Dar City, North-West Ethiopia

Background

Opioid use is a major global public health problem, affecting 16 million individuals worldwide. According to a 2023 WHO report, out of the 600,000 substance-related deaths worldwide, 80% were attributed to opioid use. Pharmacists play a vital role in reducing unnecessary opioid exposure while facilitating access to non-opioid alternatives. To do so, pharmacists should have sufficient knowledge regarding opioid-containing medications and a positive attitude about opioid use problems.

Objective

This study aimed to evaluate community pharmacists' knowledge of opioid-containing medications and their attitude toward opioid use problems.

Materials and methods

A cross-sectional study was conducted using a self-administered, structured questionnaire distributed to 105 community pharmacists from July 1-30, 2023 in Bahir Dar City, Ethiopia. The tool included demographic information and questions designed to assess participants' knowledge and attitudes.

Results

Out of the 105 pharmacists included in this study, majority were males (54.3%), nearly half held a bachelor's degree (49.5%), and slightly above one-third had over a decade experience (39%). Regarding knowledge and attitude towards opioids, 62 individuals (59%) exhibited good knowledge, and 64 (61%) demonstrated less stigma toward opioid usage. Factors affecting knowledge include: education level (AOR (95% CI): 8.43 (1.76-40.35) and 9.93 (1.04-85.33) for bachelors and postgraduates respectively and age 1.45 (1.20-1.77)]. Meanwhile, experience [AOR (95% CI): 4.64(1.20-17.90) and 4.29 (1.23-15.05)] for 5-9 years and ≥10 years respectively and education level [AOR (95% CI): 4.08 (1.40-11.93) for bachelors and 6.40 (1.42-28.96)] for postgraduates were linked to attitude.

Conclusion

A gap in knowledge and more stigmatizing behavior was observed among community pharmacists. These findings imply the importance of tailored educational interventions to address knowledge gaps and promote positive attitudes toward opioid usage among community pharmacists. Therefore, it is imperative to deliver up-to-date information on opioids, emphasizing their high addiction potential, to ensure pharmacists are well-equipped with the latest information.

Role of pharmacists in the provision of palliative care services and support in South Africa

OBJECTIVES

South Africa (SA) has high demand but inequitable access to palliative care (PC). Realising this need and the growing recognition of pharmacists' in PC globally, a study was undertaken regarding the role of pharmacists in the provision of PC services and support in SA.

METHOD

A descriptive cross-sectional quantitative study was conducted among 540 community and hospital pharmacists. A self-administered, closed-ended questionnaire covering knowledge, attitude, current role, future role and barriers to PC was used. Data was coded and analysed using SPSS® Version 24.0. P-values < 0.05 were considered statistically significant.

KEY FINDINGS

Response rate was 48.7% (n = 263). Pharmacists (72.2%) were already playing a role in PC, however, only 20.5% reported frequent involvement in PC. Services provided included medicine supply (88.2%), side-effect/symptom management (82.1%), information sharing (60.8%), bereavement counselling (60.8%), treatment/care needs (57.4%) and spiritual support (52.1%). More pharmacists (96.6%) wanted to play a role in PC, beyond medicine supply to include PC team member (91.6%), medicine reviews (91.3%), referrals (80.2%) and patient visits (50.6%). Pharmacists had a good knowledge (71.4%) and a positive attitude (61.5%) towards PC despite many health system barriers such as lack of training (91.3%), inadequate clinical experience (90.5%) and insufficient resources (77.2%).

CONCLUSIONS

Pharmacists with their high level of knowledge, positive attitude and broad scope of practice are well-placed to play a role in PC. Further strengthening and integration of their roles into the continuum of care, will encourage the involvement of more pharmacists, enhancing availability, access and resources for PC.

Pain management in hospitals: patients' satisfaction and related barriers

Background:

Suboptimal pain control has been frequently reported in healthcare settings and documented to negatively impact patients’ health. Patients’ perception regarding pain management may influence their satisfaction regarding treatment.

Objectives:

This study focuses on the assessment of patients’ satisfaction regarding pain therapy and defining patient-related barriers for its implication.

Methods:

A cross-sectional study was conducted in two tertiary care hospitals from April till July 2017. A face-to face interview questionnaire was filled regarding pain scores and patients’ attitudes regarding pain management. Both medical and post-surgical adult patients with all types of pain were eligible to participate. A descriptive analysis of patient satisfaction and perceptions regarding pain management was done.

Results:

Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization (71.6% of the cases). Numeric pain scores were recorded only in 14.2% of the patient medical files. Pain intensity documentation by healthcare professionals was found in 41.5% of the cases, and 7.7% of the patients had to wait for more than 30 minutes before getting the pain medication. Around 85% of the patients were satisfied with their pain management. Patients’ barriers to effective pain therapy were mainly fear of adverse effects, addiction, and additional costs (p<0.05).

Conclusions:

Pain remains a prevalent problem that requires more efforts for improvement. Our study can effectively serve as a start for larger studies where barriers to pain management can be assessed as an independent variable affecting pain management practice.

How do patients with cancer pain view community pharmacy services? An interview study

Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.

Multicentered Study Evaluating Pharmacy Students’ Perception of Palliative Care and Clinical Reasoning Using Script Concordance Testing

Introduction:

As the role of the pharmacist on the transdisciplinary palliative care team grows, the need for adequate instruction on palliative care and clinical reasoning skills in schools of pharmacy grows accordingly.

Methods:

This study evaluates second- and third-year pharmacy students from 6 accredited schools of pharmacy that participated in surveys before and after the delivery of a didactic palliative care elective. The survey collected student demographics, perceptions of the importance of and student skill level in palliative care topics. The script concordance test (SCT) was used to assess clinical decision-making skills on patient cases. Student scores on the SCT were compared to those of a reference panel of experts.

Results:

A total of 89 students completed the pre-/postsurveys and were included in data analysis. There was no statistically significant difference in student perceived importance of palliative care skills before and after the elective. Students from all 6 institutions showed significant increase in confidence in their palliative care skills at the end of the course. There was also a significant improvement across all institutions in clinical reasoning skills in most of the SCT questions used to assess these skills.

Conclusions:

Students choosing an elective in palliative care likely do so because they already have an understanding of the importance of these topics in their future practice settings. Delivery of a palliative care elective in the pharmacy curriculum significantly increases both student confidence in their palliative care skills and their clinical reasoning skills in these areas.

Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study

Background

One helpful strategy adopted for pain management in non-verbal, intubated patients is the use of a proper pain assessment scale. The purpose of the present study is to achieve a better and deeper understanding of the existing nurses' challenges in using pain assessment scales among patients unable to communicate.

Methods

This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until data saturation. The participants included 20 nurses working in intensive care units. Data was collected using semi-structured interviews and analysis was done using an inductive approach.

Results

Four categories and ten sub-categories were extracted from the experiences of the nurses working in the intensive care units in terms of nursing challenges in using non-verbal pain assessment scales. The four categories included "forgotten priority", "organizational barriers", "attitudinal barriers", and "barriers to knowledge".

Conclusions

The findings of the present study have shown that various factors might influence on the use of non-verbal pain assessment scales in patients unable to communicate. Identifying these challenges for nurses can help take effective steps such as empowering nurses in the use of non-verbal pain assessment scales, relieving pain, and improving the quality of care services.

Healthcare Providers' Knowledge and Current Practice of Pain Assessment and Management: How Much Progress Have We Made?

Context. Despite improvement in pain management and availability of clinical treatment guidelines, patients in Jordan are still suffering from pain. Negative consequences of undertreated pain are being recognized as a reason for further illnesses and poor quality of life. Healthcare providers (HCPs) are responsible for relieving pain of their patients. Objective. To evaluate the knowledge and attitudes of HCPs toward pain management in Jordan. Methods. A 16-item questionnaire with agree or disagree options was given to 662 HCPs in seven hospitals in Jordan who volunteered to participate in the study. Following data collection, the responses were coded and entered into SPSS. Results. There was a statistically significant difference (p < 0.004) in percentage scores between physicians (36%) and pharmacists (36%) versus nurses (24%). The level of knowledge was the best among physicians, followed by pharmacists specifically in the area of cancer pain management. Nurses scored the lowest for knowledge of pain assessment and management among HCPs. However, HCPs overall scores indicated insufficient knowledge specifically in relation to pain assessment and management among children.

Impact of a Pharmacy-Led Pain Management Team on Adults in an Academic Medical Center

Background: Pain is a major health problem affecting more than 15% of adults in the United States. In a multidisciplinary pain management team, pharmacists can optimize pharmacotherapy quality by ensuring safe and appropriate medication use. Objective: Assess the impact of a pharmacy pain medication management service on pain-related outcomes in an adult inpatient population. Methods: This retrospective study evaluated patients who were admitted from November 2009 through November 2011 and received a pharmacy pain consult. Patients were excluded if they left against medical advice, their care was assumed by palliative care, or they had no complaint of pain when seen by the pharmacist. The primary outcome was the difference between each patient's average pain score from pre-consult to post-consult. Secondary outcomes were difference between each patient's average pain score from pre-consult to pre-discharge, overall functional improvement, pharmacist interventions, and 14-day and 30-day readmissions. Results: One hundred patients were included in the final analysis. Eight hundred twenty-one interventions were made by the clinical pharmacists. Patients displayed a significant reduction in their pre- and post-consult pain intensity scores on a 0 to 10 numerical rating scale (6.15 vs 3.25; p < .001). Likewise, a significant reduction in pain intensity scores was seen from pre-consult to pre-discharge (6.15 vs 3.6; p < .001). Overall functional improvement, specifically sleep, mobility, and appetite, was seen in 86.6% of patients. Conclusions: Pain management is an area that provides opportunities for pharmacotherapy interventions. Pharmacists' involvement in pain management on an inpatient consult service had a positive impact on pain scores and improvement in functionality.

Occupational therapists' pain knowledge: a national survey

PURPOSE

This study surveyed Canadian occupational therapists to identify whether their pain knowledge is current or if the gaps identified in past studies have remained the same. The findings will provide information to guide the development of targeted pain knowledge translation strategies for occupational therapists.

METHOD

A self-report survey, including demographic questions and part of the City of Boston's Rehabilitation Professionals' Knowledge and Attitude Survey (COBS), was disseminated electronically to all members of the Canadian Association of Occupational Therapists.

RESULTS

A total of 354 therapists, most came from Ontario, Alberta and Nova Scotia and working in the community, acute care and private practice, participated. Over 50% had 10 years or less of experience. Deficit knowledge areas were identified in pediatric pain, chronic versus acute pain, pain assessment and medications. These findings are largely consistent with deficits identified in pre-2000 studies.

CONCLUSIONS

Pain knowledge gaps persist among Canadian occupational therapists and this can, and should, be addressed within the occupational therapist (OT) curriculum and in professional development initiatives. It is concerning that this study identified similar knowledge gaps as those identified in previous studies of OT students and clinicians. Pain is a growing and complex issue with negative impact on occupational performance across the lifespan. Knowledge dissemination of occupational therapy pain assessment and management approaches should be a priority for the profession.

IMPLICATIONS FOR REHABILITATION

Pain is a prevalent condition in all age groups of occupational therapists' clients. There appear to be gaps in occupational therapists' evidence-based knowledge of aspects of pain. Occupational therapy training programs and occupational therapy associations should provide education with a particular focus on identified pain knowledge gaps.

The role of a pharmacist in a hospice: a nationwide survey among hospice directors, pharmacists and physicians

Background

Palliative care requires the collaborative efforts of an interdisciplinary team, and as such a range of health professionals should be involved in supporting patients with life-threatening diseases. As a part of this therapeutic network, pharmacists at residential hospices should be thoroughly involved in care, cooperate with other medical staff and perform pharmaceutical services in order to deliver safe and efficient pharmacotherapy.

Aim

To provide an overview of the current state of pharmacy practice at Polish residential hospices.

Methods

A cross-sectional study was applied and three types of anonymous questionnaires were developed to collect data. Hospice directors, pharmacists and physicians from all residential hospices in Poland were invited to participate.

Results

19 (61%) hospices collaborate with at least one pharmacist, who performs pharmaceutical services on the premises. 12 (75%) pharmacists provide advice concerning medicines and 11 (69%) are involved in various roles related to procurement, dispensing and storage of drugs, as well as creating procedures for these activities. Despite pharmacists' great level of involvement in drug policy, most of them are not members of the therapeutic team and they do not participate in ward rounds. Furthermore, the provision of clinical pharmaceutical services forms a minority of Polish hospital pharmacy practice.

Conclusions

Although the role of a hospice-based pharmacist is focused on the provision of drugs, it should become more clinical, that is, more patient oriented. The data obtained should be used as a source of information for implementing potential changes to palliative care pharmacy.

Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice

BACKGROUND

We have previously reported the development of an outpatient palliative care practice under pharmacist-physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients.

OBJECTIVE

This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice.

METHODS

This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed.

RESULTS

Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients (n = 80) were mostly women (n = 44), had localized disease (n = 42), a gastrointestinal cancer type (n = 21), and were on a long-acting (n = 61) and short-acting (n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits.

CONCLUSIONS

A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits.