1
|
Rao D, Ford JH, Shiyanbola OO. Patient and pharmacist perspectives on opioid misuse screening and brief interventions in community pharmacies. Addict Sci Clin Pract 2024; 19:27. [PMID: 38589965 PMCID: PMC11003152 DOI: 10.1186/s13722-024-00460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Pharmacy-based screening and brief interventions (SBI) offer opportunities to identify opioid misuse and opioid safety risks and provide brief interventions that do not overly burden pharmacists. Currently, such interventions are being developed without patient input and in-depth contextual data and insufficient translation into practice. The purpose of this study is to qualitatively explore and compare patient and pharmacist perceptions and needs regarding a pharmacy-based opioid misuse SBI and to identify relevant SBI features and future implementation strategies. METHODS Using the Consolidated Framework for Implementation Research, we conducted semi-structured interviews with 8 patients and 11 pharmacists, to explore needs and barriers to participating in a pharmacy-based SBI. We recruited a purposive sample of English-speaking patients prescribed opioids for chronic or acute pain and pharmacists practicing in varied pharmacies (small independent, large-chain, specialty retail) settings. We used an inductive content analysis approach to analyze patient interview data. Then through a template analysis approach involving comparison of pharmacist and patient themes, we developed strategies for SBI implementation. RESULTS Most patient participants were white, older, described living in suburban areas, and were long-term opioid users. We identified template themes related to individual, interpersonal, intervention, and implementation factors and inferred applications for SBI design or potential SBI implementation strategies. We found that patients needed education on opioid safety and general opioid use, regardless of opioid use behaviors. Pharmacists described needing patient-centered training, protocols, and scripts to provide SBI. A short-self-reported screening and brief interventions including counseling, naloxone, and involving prescribers were discussed by both groups. CONCLUSIONS Through this implementation-focused qualitative study, we identified patient needs such as opioid safety education delivered in a private and convenient format and pharmacist needs including training, workflow integration, protocols, and a time-efficient intervention for effective pharmacy-based SBI. Alternate formats of SBI using digital health technologies may be needed for effective implementation. Our findings can be used to develop patient-centered pharmacy-based SBI that can be implemented within actual pharmacy practice.
Collapse
Affiliation(s)
- Deepika Rao
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53703, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.
| | - James H Ford
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53703, USA
| | - Olayinka O Shiyanbola
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53703, USA
| |
Collapse
|
2
|
Alkhiyami DI, Higazy AS, Saad MO. A survey on the knowledge and attitudes of pharmacists towards the application of antimicrobial therapeutic drug monitoring and its challenges in Qatar. PLoS One 2024; 19:e0297699. [PMID: 38412165 PMCID: PMC10898731 DOI: 10.1371/journal.pone.0297699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Therapeutic drug monitoring (TDM) is an integral part of pharmaceutical care. Antimicrobials are amongst the most commonly monitored medications. Therefore, identifying the gaps in antimicrobial pharmacokinetics and TDM knowledge and skills among pharmacists is crucial to optimize TDM application. RESEARCH QUESTION What is the current knowledge, attitudes and perceived barriers of pharmacists in Qatar towards the application of antimicrobial TDM? STUDY DESIGN Cross-sectional survey. METHODS The psychometric validation of the survey underwent 3 stages: domain identification and item generation, content validation, and pilot test. The survey was divided into 4 domains (participant characteristics, knowledge, attitudes, and perceived barriers). It was developed in Survey Monkey and distributed to all pharmacists in Hamad Medical Corporation (HMC) hospitals via email. Data was analyzed using IBM Statistical Package for the Social Sciences (SPSS). Categorical and quantitative variables were expressed as frequencies with percentages and medians with interquartile ranges, respectively. Mann-Whitney U-test was used to test the effect of demographic and professional parameters on the knowledge scores. P values less than 0.05 were considered significant. RESULTS Forty-nine responses were collected. The median age of respondents was 34 years and 51% of them were males. Most respondents were clinical pharmacists (47%). On average, 44% of knowledge questions were correct, whereas 32% were incorrect and 23% were not sure of the answer. The median knowledge score was 5 out of 10 (interquartile range 2.5-6). Participants with post-graduate degrees or prior pharmacokinetic training showed trends towards higher knowledge scores. Online pharmacokinetics calculators were the most frequently used dose adjustment method. The top perceived barriers for the implementation of antimicrobial TDM were lack of knowledge and lack of educational sessions. CONCLUSIONS Albeit pharmacists in Qatar had modest level of knowledge about antimicrobial TDM, they had positive attitudes towards TDM and its implications in the clinical practice. Future plans should include providing TDM-related education activities.
Collapse
Affiliation(s)
- Dania Ihsan Alkhiyami
- Clinical Pharmacy Department, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alya Salah Higazy
- Clinical Pharmacy Department, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Omar Saad
- Clinical Pharmacy Department, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
3
|
Rao D, McAtee C, Mercy M, Shiyanbola OO, Ford JH. An Implementation-Focused Qualitative Exploration of Pharmacist Needs Regarding an Opioid Use Disorder Screening and Brief Intervention. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:24-32. [PMID: 38258852 DOI: 10.1177/29767342231211428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Screening and brief interventions (SBI) can help identify opioid safety risks and healthcare professionals can accordingly intervene without a significant increase in workload. Pharmacists, one of the most accessible healthcare professionals, are uniquely positioned to offer SBI. To design an effective intervention with high potential for implementation, we explored pharmacist needs and barriers regarding SBI for opioid use disorders. METHODS Using the Consolidated Framework for Implementation Research (CFIR), we conducted 11 semi-structured 60-minute interviews with community pharmacists. We used a purposeful sample of English-speaking pharmacists practicing in varied pharmacies (small independent, large-chain, specialty-retail) and positions (managers, owners, full-time/part-time pharmacists). Transcriptions were analyzed using deductive content analysis based on CFIR constructs, followed by inductive open coding. Utilizing a theoretical framework for data collection and analysis, a diverse sample of pharmacist roles, peer debriefing, and 2 independent coders for each transcript, altogether increased the credibility and transferability of our research. Data collection and analysis continued until data saturation was achieved. RESULTS Pharmacists described good working relationships with colleagues, organization cultures that were open to new initiatives, and believed the SBI to be compatible with their organization goals and pharmacy structure, which are facilitators for future SBI implementation. Pharmacists were motivated by improved patient outcomes, more patient interaction and clinical roles, representing facilitators at the individual level. They also described stigma toward patients, mixed need for change, and lack of knowledge regarding SBI, which are potential barriers to be addressed. Pharmacists believed that the SBI model was adaptable, not complicated, and benefits outweighed implementation costs. CONCLUSIONS We addressed current SBI literature gaps-mainly lack of focus on implementation and contextual data, through rigorous implementation-focused qualitative research. Our exploratory findings have direct implications on future pharmacy-based SBI implementation.
Collapse
Affiliation(s)
- Deepika Rao
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Meg Mercy
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - James H Ford
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
4
|
Tay E, Makeham M, Laba TL, Baysari M. Prescription drug monitoring programs evaluation: A systematic review of reviews. Drug Alcohol Depend 2023; 247:109887. [PMID: 37126936 DOI: 10.1016/j.drugalcdep.2023.109887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) are used to mitigate harms from high-risk medicines including misuse, prescription shopping, overdoses, and death. Previous systematic reviews report inconsistent findings. We undertook a systematic review of reviews to 1) describe and identify the methods and outcome measures used to evaluate PDMPs, 2) summarise existing evidence on outcomes and factors that influence PDMP success or benefit realisation. METHODS MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews, and PROSPERO were used to identify systematic reviews on PDMPs. Twelve papers met the inclusion criteria. Data extracted included review aim, study designs, settings, outcome measures, and key findings. Quality was assessed using AMSTAR 2 quality assessment tool. RESULTS Review papers were categorised as outcome or process evaluation reviews. Process evaluation reviews described implementation processes, barriers and facilitators to PDMP use and/or implementation. Most (57%) papers described barriers which frequently included usability and data integration. Outcome evaluation papers reported impact of PDMPs on outcomes, which were opioid-focused, and findings were highly variable. Most reviews (67%) were rated as low quality, limiting the conclusions that can be drawn. CONCLUSIONS Inconsistent methods and outcome measures were used to evaluate PDMPs. No economic evaluations of PDMPs were found. Standardising assessment and reporting of results may improve the quality and confidence in an evidence-base to inform future roll-out and evaluation of PDMPs. Targeting barriers such as system-related challenges and negative end-user perceptions could improve sustained uptake of PDMPs, and potentially facilitate benefits realisation, including mitigating harms of high-risk prescription medicines.
Collapse
Affiliation(s)
- Emma Tay
- Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, The University of Sydney, Australia; Drug Health Service, Western Sydney Local Health District, Australia.
| | - Meredith Makeham
- Faculty of Medicine and Health, The University of Sydney, Australia; Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Tracey-Lea Laba
- Clinical and Health Sciences, University of South Australia, Australia; Centre for Health Economics Research and Evaluation, The University of Technology Sydney, Australia
| | - Melissa Baysari
- Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, The University of Sydney, Australia
| |
Collapse
|
5
|
Picco L, Lam T, Xia T, Nielsen S. Factors associated with prescription drug monitoring program utilisation: a cross-sectional survey of community pharmacists. Int J Clin Pharm 2023; 45:421-429. [PMID: 36528707 PMCID: PMC9759276 DOI: 10.1007/s11096-022-01523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are databases which collect prescribing and dispensing information for high-risk medicines, and are one approach to mitigate prescription opioid-related risks. AIM To examine correlates of PDMP use under voluntary and mandatory conditions, among a representative sample of community pharmacists in Victoria, Australia. METHOD An online anonymous survey was conducted and collected data in relation to pharmacist and pharmacy characteristics, comfort in performing certain tasks, PDMP training and the frequency of PDMP use under voluntary and mandatory conditions. Multivariate logistic regression models were performed to determine the effect of each covariate on voluntary and mandatory PDMP use. RESULTS In total, 265 pharmacists participated (response rate 47%). Under voluntary conditions, a quarter of pharmacists (24.9%) used the PDMP all the time, while half (51.7%) used the PDMP all of the time, once mandated. Pharmacies that stocked naloxone (OR: 1.96; 95% CI 1.11-3.45) and pharmacists that had attended formal PDMP training (OR: 1.78; 95% CI 1.05-3.05), were significantly associated with regular PDMP use under voluntary conditions. Under mandatory conditions, increased odds of PDMP use were associated with pharmacies that stocked naloxone (OR: 1.88; 95% CI 1.06-3.34). Pharmacists working in regional and rural areas had significantly lower odds (OR: 0.35; 95% CI 0.20-0.63) of always using the PDMP, as did pharmacists with > 15 years' experience (OR: 0.24; 95% CI 0.11-0.51) once use was mandated. CONCLUSION Given that PDMP utilisation was slower or less regular amongst pharmacists located in regional and rural areas, pharmacists with more years of experience and those not already supplying naloxone, targeted training aimed at these sub-populations may be beneficial.
Collapse
Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| |
Collapse
|
6
|
Skoy E, Frenzel O, Eukel H, Lothspeich E, Steig J, Strand M, Werremeyer A. Evaluation of a Program to Screen Patients in Community Pharmacies for Opioid Misuse and Accidental Overdose. Prev Chronic Dis 2022; 19:E41. [PMID: 35834737 PMCID: PMC9336191 DOI: 10.5888/pcd19.220028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Community pharmacies nationwide have adopted new strategies to combat the opioid epidemic. One strategy to prevent opioid misuse and accidental overdose is patient screening to identify those at risk. The purpose of our study was to determine whether such screening in community pharmacies led pharmacy personnel to intervene with patients at risk and to describe the proportion of patients they identified as at risk. Methods We implemented the Opioid and Naloxone Education (ONE) program in North Dakota to give community pharmacies and pharmacists training and tools to provide preventive screening for opioid misuse and accidental overdose before dispensing a prescribed opioid. Data were collected and analyzed from September 15, 2018, through May 15, 2021, to evaluate overall patient risk characteristics for opioid misuse and accidental overdose. Results Of 8,217 patients screened, 3.9% were identified as at high risk for opioid misuse, and 18.3% at risk for accidental overdose. Nearly 1 of 3 screenings (31.7%) indicated opioid medication use in the past 60 days. Pharmacists delivered 1 or more risk-factor–dependent interventions to 41.1% of patients in the study. Following screening, naloxone dispensing in pharmacies increased to 6 times the national average. Conclusion Pharmacy-based patient screening for risk of opioid misuse and accidental overdose led to risk-dependent interventions targeted to individual patients. The tools and risk-dependent interventions applied in the ONE program increased patient awareness of opioid risks and ways to reduce risk. Future studies should examine long-term outcomes, including reduction in overdose, treatment of opioid use disorder, and reduced opioid-related acute care.
Collapse
Affiliation(s)
- Elizabeth Skoy
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58108.
| | - Oliver Frenzel
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Heidi Eukel
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Emily Lothspeich
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Jayme Steig
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Mark Strand
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Amy Werremeyer
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| |
Collapse
|
7
|
Zhang Z, Guo L, Si R, Chalmers L, Filippin P, Carpenter J, Czarniak P. Pharmacists' perceptions on real-time prescription monitoring (RTPM) – A cross-sectional survey. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100122. [PMID: 35478517 PMCID: PMC9032446 DOI: 10.1016/j.rcsop.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/26/2022] [Accepted: 02/27/2022] [Indexed: 10/27/2022] Open
|
8
|
Hoppe D, Karimi L, Khalil H. Mapping the research addressing prescription drug monitoring programs: A scoping review. Drug Alcohol Rev 2022; 41:803-817. [PMID: 35106867 DOI: 10.1111/dar.13431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.
Collapse
Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
9
|
Hastings TJ, Ha D, Fox BI, Qian J, Lakin J, Westrick SC. Increasing Use of Immunization Information Systems for Routine Vaccinations in Independent Community Pharmacies: A Randomized Controlled Trial. J Am Pharm Assoc (2003) 2022; 62:1270-1279.e2. [PMID: 35292212 PMCID: PMC8917836 DOI: 10.1016/j.japh.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/03/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022]
|
10
|
"Nobody Knows How You're Supposed to Interpret it:" End-user Perspectives on Prescription Drug Monitoring Program in Massachusetts. J Addict Med 2022; 16:e171-e176. [PMID: 34417413 PMCID: PMC8857300 DOI: 10.1097/adm.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES America's overdose crisis spurred rapid expansion in the number and scope of prescription drug monitoring programs (PDMPs). As their public health impact remains contested, little is known about PDMP user experiences and perspectives. We explore perspectives of PDMP end-users in Massachusetts. METHODS Between 2016 and 2017, we conducted semi-structured qualitative interviews on overdose crisis dynamics and PDMP experiences with a purposive sample of 18 stakeholders (prescribers, pharmacists, law enforcement, and public health regulators). Recordings were transcribed and double-coded using a grounded hermeneutic approach. RESULTS Perspectives on prescription monitoring as an element of overdose crisis response differed across sectors, but narratives often critiqued PDMPs as poorly conceived to serve end-user needs. Respondents indicated that PDMP: (1) lacked clear orientation towards health promotion; (2) was not optimally configured or designed as a decision support tool, resulting in confusion over interpreting data to guide health care or law enforcement actions; and, (3) problematized communication and relationships between prescribers, pharmacists, and patients. CONCLUSIONS User insights must inform design, programmatic, and policy reform to maximize PDMP benefits while minimizing harm.
Collapse
|
11
|
Abstract
OBJECTIVE To measure the impact of the implementation of a law that allows pharmacists to provide naloxone under a physician-approved protocol on naloxone dispensing rates in an all-payer population across the United States. METHODS Prescription claims from a national grocery chain for 31 states and Area Heath Resource File were used for this retrospective study. The study sample included all patients who filled at least one naloxone prescription during the study period from July 16, 2014 to January 16, 2017. A stepwise autoregression was performed for 30 consecutive months to evaluate the change in naloxone prescription dispensing rate. The primary independent variable was "implementation of the physician-approved protocol." The primary outcome measure was the rate of naloxone prescriptions dispensed per month per state. Secondary outcome measures were naloxone dispensing rates by each payer. RESULTS Number of patients who received naloxone prescriptions in the states with physician-approved protocol was 423% higher compared to states without the protocol. The overall model showed that the naloxone dispensing rate was 6 times higher in the states with a physician-approved protocol. In the payer-based models, comparing states with and without protocol, the dispensing rate was highest for Medicare (9.0 times) followed by Private (4.6 times), Medicaid (3.2 times), and Cash (3.1 times). The number of prescriptions dispensed in the low-employment states with the protocol was 17.59 times higher compared to states without the protocol. CONCLUSIONS Implementation of physician-approved protocol was strongly associated with an increase in naloxone dispensing rates, especially in the low-employment states.
Collapse
|
12
|
Arnold A, Bentley JP, Patel A, Holmes E. Predictors of pharmacists' likelihood to query prescription drug monitoring program databases. J Am Pharm Assoc (2003) 2021; 61:614-622.e3. [PMID: 33994328 DOI: 10.1016/j.japh.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Low rates of enrollment and querying of the prescription drug monitoring programs (PDMPs) may be detrimental to the effectiveness of controlling prescription drug misuse. A number of individual-level, organizational, and regulatory factors may affect a community pharmacist's likelihood to query their statewide PDMP. OBJECTIVE To identify predictors of pharmacists' likelihood to query the PDMP. METHODS A self-administered survey was used to collect data from community pharmacists from a national panel. Measures were identified from previous literature assessing provider likelihood to query PDMPs. A principal components analysis of items pertaining to pharmacists' likelihood to query PDMPs was conducted as a data reduction technique to identify underlying dimensions. Multivariable linear regression was conducted to examine relationships between 5 predictor variables (state regulations, practice setting, workload, perceived barriers, and attitude) and the identified components. RESULTS A total of 148 completed survey responses were included for final analysis. The pharmacists'-likelihood-to-query scale comprised 2 components accounting for 71% of the total variance. The 2 components were labeled as higher-risk situations and lower-risk situations. Multivariable linear regression indicated that pharmacists' likelihood to query the PDMP for the higher-risk situations was not statistically significant for any predictor variables. For the lower-risk situations, pharmacists who had a more positive attitude toward the effectiveness of the PDMP were more likely to query it in these situations (unstandardized coefficient = 0.167; P = 0.018). CONCLUSION The factors affecting pharmacists' likelihood to query the PDMP may differ depending on the situations faced by the pharmacist. On the basis of the study results, it seems that pharmacists are currently aware of the importance of checking the PDMP and regularly query it. Overall, the respondent pharmacists had a positive attitude toward the effectiveness of the PDMP, which seems to have a role in their likelihood to query it in lower-risk situations.
Collapse
|
13
|
The use of an integrated opioid and medical marijuana prescription drug monitoring program. J Am Pharm Assoc (2003) 2021; 61:408-417. [PMID: 33903060 DOI: 10.1016/j.japh.2021.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To (1) identify the reasons for which pharmacists in Connecticut use the CPMRS when dispensing opioid medications and medical marijuana products, (2) determine pharmacists' perceived value of the CPMRS when dispensing opioids or medical marijuana, and (3) compare practices and the perceived value of the CPMRS among community-based pharmacists (CBPs) and medical marijuana dispensary pharmacists (MMDPs). METHODS An online survey was administered from May 2019 to June 2019 to CBPs (n = 178) and MMDPs (n = 12). The survey included items about background, use, and attitudes about current and future use of the CPMRS. RESULTS Both pharmacist groups indicated that opioid use information was the most useful aspect of the CPMRS. Ninety percent of both groups checked patients' use of opioids using the CPMRS, and 81.2% of the MMDPs compared with 38.4% of the CBPs indicated that they checked for patients' use of medical marijuana. A greater percentage of MMDPs than CBPs felt that access to the marijuana use information was useful and needed for counseling. Several pharmacists recommended improvements in marijuana use information in the CPMRS and greater efficiencies for users of the system. CONCLUSION Access to both marijuana and opioid use information can allow pharmacists to make specific recommendations on the basis of potential drug interactions and dose adjustments. The results from the present study highlight how integrated systems of opioid and marijuana dispensing information can be further enhanced by resolving existing pharmacy barriers involving technology, workflow, and need for systems with more detailed marijuana product information.
Collapse
|
14
|
Upton C, Gernant SA, Rickles NM. Prescription drug monitoring programs in community pharmacy: An exploration of pharmacist time requirements and labor cost. J Am Pharm Assoc (2003) 2020; 60:943-950. [DOI: 10.1016/j.japh.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/21/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
|
15
|
Thakur T, Chewning B. Using role theory to explore pharmacist role conflict in opioid risks communication. Res Social Adm Pharm 2020; 16:1121-1126. [DOI: 10.1016/j.sapharm.2019.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023]
|
16
|
Delcher C, Pauly N, Moyo P. Advances in prescription drug monitoring program research: a literature synthesis (June 2018 to December 2019). Curr Opin Psychiatry 2020; 33:326-333. [PMID: 32250984 PMCID: PMC7409839 DOI: 10.1097/yco.0000000000000608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Nearly every U.S. state operates a prescription drug monitoring program (PDMP) to monitor dispensing of controlled substances. These programs are often considered key policy levers in the ongoing polydrug epidemic. Recent years have seen rapid growth of peer-reviewed literature examining PDMP consultation and the impacts of these programs on diverse patient populations and health outcomes. This literature synthesis presents a review of studies published from June 2018 to December 2019 and provides relevant updates from the perspective of three researchers in this field. RECENT FINDINGS The analyzed studies were primarily distributed across three overarching research focus areas: outcome evaluations (n = 29 studies), user surveys (n = 23), and surveillance (n = 22). Identified themes included growing awareness of the unintended consequences of PDMPs on access to opioids, effects on benzodiazepines and stimulant prescribing, challenges with workflow integration across multiple specialties, and new opportunities for applied data science. SUMMARY There is a critical gap in existing PDMP literature assessing how these programs have impacted psychiatrists, their prescribing behaviors, and their patients. Although PDMPs have improved population-level monitoring of controlled substances from medical sources, their role in responding to a drug epidemic shifting to illicitly manufactured drugs is under scrutiny.
Collapse
Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Nathan Pauly
- Department of Health Policy Management and Leadership, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
17
|
Irwin AN, Novak K, Alley L, Havlin T, O’Kane N, Johnston K, Hildebran C, Carson J, Hartung DM. Impact of the RESPOND Toolkit on community pharmacists’ opioid safety attitudes, self-efficacy, and knowledge. J Am Pharm Assoc (2003) 2020; 60:450-455.e3. [DOI: 10.1016/j.japh.2019.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/28/2019] [Accepted: 11/23/2019] [Indexed: 11/30/2022]
|
18
|
Alley L, Novak K, Havlin T, Irwin AN, Carson J, Johnston K, O'Kane N, Hartung DM. Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists. Res Social Adm Pharm 2020; 16:1422-1430. [PMID: 31953112 DOI: 10.1016/j.sapharm.2019.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/29/2019] [Accepted: 12/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pharmacists' role in addressing the opioid crisis continues to expand, but lack of training specifically related to standardized prescription drug monitoring program (PDMP) use and communication strategies for provider and patient interactions remains a significant issue. We developed the Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit to enhance community pharmacists' understanding of their role in addressing opioid safety; improve integration of PDMP into daily workflow; and enhance communication between pharmacists, prescribers, and patients. OBJECTIVE To describe the development of RESPOND Toolkit and summarize findings from initial pilot testing. METHODS RESPOND development was informed by focus groups with patients, prescribers, and pharmacists and an external advisory committee. Materials developed include a patient screening & communication algorithm, a provider communication checklist and an online continuing education course with three distinct modules. The RESPOND Toolkit was pilot tested in six community pharmacies in Oregon across two 6-month intervention phases. Pilot data collection included a pre-post intervention survey, pre-post knowledge assessment quizzes within the online course, and post-intervention semi-structured interviews. Interview feedback informed revisions after each phase to shape the final content, flow, and delivery of RESPOND. RESULTS Sixteen of 21 pharmacists completed the online training, revealing a large, significant effect on knowledge gain across the three training modules (pre-score 57, post-score 84; p < 0.001; Cohen's d = 1.85). Of these participants, 10 also completed the baseline and post intervention survey and showed non-significant moderate improvements in knowledge, perceived behavioral control, and self-efficacy to address opioid safety issues. CONCLUSION The RESPOND Toolkit has promise as an effective and scalable approach to providing community pharmacist-tailored training, especially in the areas of effective communication and workflow integration, to promote behavioral shifts supporting opioid safety for patients. Further development and testing in a larger sample is warranted.
Collapse
Affiliation(s)
- Lindsey Alley
- Comagine Health, 650 NE Holladay St., Suite 1700, Portland, OR, 97232, USA
| | - Kevin Novak
- Comagine Health, 650 NE Holladay St., Suite 1700, Portland, OR, 97232, USA
| | - Tyler Havlin
- Comagine Health, 650 NE Holladay St., Suite 1700, Portland, OR, 97232, USA
| | - Adriane N Irwin
- Oregon State University, College of Pharmacy, 2730 SW Moody Ave., Mailcode: CL5CP, Portland, OR, 97201, USA
| | - Jody Carson
- Comagine Health, 650 NE Holladay St., Suite 1700, Portland, OR, 97232, USA
| | - Kirbee Johnston
- Oregon State University, College of Pharmacy, 2730 SW Moody Ave., Mailcode: CL5CP, Portland, OR, 97201, USA
| | - Nicole O'Kane
- Comagine Health, 650 NE Holladay St., Suite 1700, Portland, OR, 97232, USA
| | - Daniel M Hartung
- Oregon State University, College of Pharmacy, 2730 SW Moody Ave., Mailcode: CL5CP, Portland, OR, 97201, USA.
| |
Collapse
|
19
|
Bach P, Hartung D. Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders. Addict Sci Clin Pract 2019; 14:30. [PMID: 31474225 PMCID: PMC6717996 DOI: 10.1186/s13722-019-0158-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022] Open
Abstract
The global rise in opioid-related harms has impacted the United States severely. Current efforts to manage the opioid crisis have prompted a re-evaluation of many of the existing roles in the healthcare system, in order to maximize their individual effects on reducing opioid-associated morbidity and preventing overdose deaths. As one of the most accessible healthcare professionals in the US, pharmacists are well-positioned to participate in such activities. Historically, US pharmacists have had a limited role in the surveillance and treatment of substance use disorders. This narrative review explores the literature describing novel programs designed to capitalize on the role of the community pharmacist in helping to reduce opioid-related harms, as well as evaluations of existing practices already in place in the US and elsewhere around the world. Specific approaches examined include strategies to facilitate pharmacist monitoring for problematic opioid use, to increase pharmacy-based harm reduction efforts (including naloxone distribution and needle exchange programs), and to involve community pharmacists in the dispensation of opioid agonist therapy (OAT). Each of these activities present a potential means to further engage pharmacists in the identification and treatment of opioid use disorders (OUDs). Through a careful examination of these approaches, we hope that new strategies can be adopted to leverage the unique role of the community pharmacist to help reduce opioid-related harms in the US.
Collapse
Affiliation(s)
- Paxton Bach
- British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Daniel Hartung
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Robertson Collaborative Life Science Building, 2730 SW Moody Ave, CL5CP, Portland, OR, 97201-5042, USA
| |
Collapse
|
20
|
Bratberg JP, Smothers ZPW, Collins K, Erstad B, Ruiz Veve J, Muzyk AJ. Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jeffrey P. Bratberg
- Department of Pharmacy Practice; University of Rhode Island College of Pharmacy; Kingston Rhode Island
| | | | - Kathryn Collins
- Doctor of Pharmacy Program; Campbell University College of Pharmacy and Health Sciences; Buies Creek North Carolina
| | - Brian Erstad
- Department of Pharmacy Practice and Science; University of Arizona College of Pharmacy; Tucson Arizona
| | - Jennifer Ruiz Veve
- Doctor of Pharmacy Program; Campbell University College of Pharmacy and Health Sciences; Buies Creek North Carolina
| | - Andrew J. Muzyk
- Department of Pharmacy Practice; Campbell University College of Pharmacy and Health Sciences; Buies Creek North Carolina
| |
Collapse
|
21
|
Thakur T, Frey M, Chewning B. Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States. PHARMACY 2019; 7:pharmacy7020060. [PMID: 31200469 PMCID: PMC6632048 DOI: 10.3390/pharmacy7020060] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Pharmacist roles promoting safe opioid use are recognized in literature and practice. Pharmacists can offer services such as counseling on opioid risks, naloxone dispensing, education on opioid storage and disposal, prescription drug monitoring program (PDMP) utilization, opioid deprescribing, and providing resources for addiction treatment to help mitigate the opioid crisis. Objective: This commentary seeks to describe current and potential roles for pharmacists to combat the United States opioid crisis and identify key factors affecting service provision. Methods: The paper summarizes evidence-based studies describing current pharmacist roles and services, factors affecting service implementation, and strategies to further improve pharmacist roles and services related to promoting safe opioid use for patients. Results: Pharmacists recognize their roles and responsibilities to counsel patients on opioid risks, dispense naloxone, educate on opioid storage and disposal, utilize prescription drug monitoring programs (PDMPs), offer opioid deprescribing, and provide resources for addiction treatment. However, pharmacists express low confidence, time, and training as barriers to service provision. This suggests a need for structured training, resources, and organizational support for pharmacists to improve confidence and participation in such services. Conclusions: Although pharmacists are aware of roles and responsibilities to help reduce the opioid crisis, more training, education, organizational support and resources are needed to increase their ability to embody these roles.
Collapse
Affiliation(s)
- Tanvee Thakur
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
| | - Meredith Frey
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
| | - Betty Chewning
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
| |
Collapse
|