The relationship between knowledge, attitudes, and practices of community pharmacists regarding persons with substance use disorders

Development of a brief stigma and perceptions questionnaire for pharmacists: An exploratory factor analysis approach in New York state counties enrolled in the healing communities study

INTRODUCTION

Little is known about how pharmacists' attitudes and stigma toward naloxone and Medication for opioid use disorder (MOUD) influence effective linkage to treatment. We examine the psychometrics of a new Pharmacist Opioid Use Disorder Perceptions Questionnaire (P-OUDP-Q), a multidimensional measure to examine pharmacists' stigma and perceptions related to MOUD in the New York State (NYS) site of the HEALing Communities Study.

METHODS

The study recruited a sample of 324 pharmacists from 16 counties in NYS between January and June 2022. A 74-item questionnaire assessed pharmacists' familiarity with opioid-related medications, protocols, policies and attitudes regarding their role, confidence, and beliefs centered around delivery of MOUD and naloxone in the community. Exploratory factor analysis assessed individual and community-level factors associated with four underlying constructs. Factor scores were compared across the demographic predictors. Variables factor loadings <0.4 were eliminated from the factor analysis and the process was reiterated.

RESULTS

Eighty-six percent (n = 280) of the pharmacists were white. A little over half, 57 % (n = 186), were female, 35 % (n = 113) were 30-35 years old. The mean number of years practicing (SD) was 18 (SD: 13). Exploratory factor analysis identified four underlying constructs: (1) practice confidence, (2) practice familiarity, (3) practice attitudes, and (4) methadone attitudes. Statistically significant (p < .05) mean factor scale score differences by race were observed for practice familiarity (white reporting higher than non-white); by pharmacy size for practice familiarity (across all groups; non-significant Tukey post-hoc) and practice attitudes (hospital/clinic greater than big chain pharmacies); by gender (males greater than females) for practice familiarity and methadone attitudes; by poverty quartile for practice attitudes (lowest less than highest quartile); and urban versus rural pharmacist county setting for practice familiarity (rural greater than urban).

CONCLUSIONS

Findings show the P-OUDP-Q is a concise measure of pharmacists' perceptions of their role in dispensing MOUD and naloxone, including distinct "stigma" dimensions, which is valuable for use with pharmacists in communities highly impacted by the opioid epidemic. The development and validation of a reliable measure to assess pharmacists' perceptions of stigma and barriers represents a valuable contribution to the field, to inform the design/implementation of targeted interventions and support systems.

Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study

BACKGROUND

Although pharmaceutical care has tangible positive importance in ensuring patient pharmacotherapy safety, its provision encounters several barriers. Therefore, this study investigated the obstacles pharmacy professionals faced while providing pharmaceutical care in Motta town, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted from July 30, 2022, to August 30, 2022, at all community and hospital pharmacies in Motta town, Northwest Ethiopia. The data were collected via a self-administered questionnaire and analyzed via SPSS version 26.0. Descriptive statistics and statistical analysis tests, such as the independent t-test, variance, and multiple linear regressions, were employed to analyze the data.

RESULTS

The study had a 97.7% response rate. Among the 130 participants, 71 (54.6%) were females. The mean (± SD) total score of pharmaceutical care provision barriers was 85.06 (± 20.2). The highest and lowest mean subscale scores of pharmaceutical care provision barriers were related to lack of resources and skill, respectively. Among resource-related barriers, lack of time and money, lack of trained staff, and lack of private space for consultation scored higher than other barriers. Concerning vision/attitudinal barriers, patients and other healthcare workers' inappropriate attitudes toward pharmaceutical care obtained the highest scores. The lack of clinical education in pharmaceutical care, lack of communication, and lack of documentation skills of pharmacists scored higher than other barriers in the educational and skill-related barriers subscales. For the regulatory/environmental subscale, a lack of clinical practice guidelines and legal barriers scored higher than the other subscales did. Pharmaceutical care provision barriers were significantly associated with age (B = 14.008), years of practice (B = 13.009), and graduating institution (B=-16.773).

CONCLUSIONS

Resource and attitudinal/vision-related barriers were reported to be the most common barriers to pharmaceutical care implementation. Stakeholders should work together to develop strategic solutions to overcome these barriers and thus achieve optimal pharmaceutical care provision. These strategies should include optimizing the number of trained pharmacy staff, time and financial problems should be resolved, communication and documentation skills should be improved, pharmacy layouts should incorporate private counseling rooms, policies that support the pharmacist's role in patient care should be developed, and effective training and continuing professional education programs should be offered.

Play for hospitalized children: A qualitative enquiry of behaviour and motivation of nurses in a secondary level healthcare setting in Ghana

BACKGROUND

The World Health Organization recommends that healthcare workers, specifically doctors and nurses, utilize play within treatment and care to promote recovery and overall well-being of hospitalized children. This recommendation has extended the roles of nurses in pediatric settings to include play in their routine care for children hospitalized for various childhood illnesses. Nurses need to draw on their skills to use play as an essential tool to aid communication, assessment, diagnosis, and care of the hospitalized child. This study explored the behaviour and motivation of Ghanaian nurses towards the utilization of play for hospitalized children.

METHODS

Exploratory qualitative design was utilized and 12 registered nurses from the pediatric unit of a secondary-level health institution were selected purposively and interviewed using a semi-structured interview guide. Thematic analysis was done with two themes namely behaviour towards play and motivation to use play emerging with their corresponding sub-themes.

FINDING

In the study setting, play has not been formalized or fully integrated into the routine care of the sick child. Nurses have a positive attitude and believe in the positive impact of play on the sick child. Participants utilize play as and when there is a need, and they derive satisfaction and fulfilment anytime they engage in play activities with their patients. Lack of administrative support and resources for play interventions affect their motivation to use play for the children.

CONCLUSION

Formalization of play and integration of play into the routine care of the sick child is needed to motivate nurses to engage hospitalized children in play activities to help them derive the full benefits that play offers to the sick and hospitalized child.

IMPLICATIONS TO PRACTICE

The positive attitudes and behaviour towards play as demonstrated in this study calls for Ghanaian nurses in general to be empowered through the formalization and integration of play into routine nursing care.

Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review

PURPOSE

In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma.

METHOD

The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality.

RESULTS

A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention.

CONCLUSIONS

SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.

An Implementation-Focused Qualitative Exploration of Pharmacist Needs Regarding an Opioid Use Disorder Screening and Brief Intervention

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.

Assessing Stigma towards Mental Illness in Relation to Demographics Attitudes and Past Experiences among Pharmacy Students in a Jordanian University Sample

Stigma towards mental illness poses a significant risk for negative mental health outcomes. Efforts have been undertaken to mitigate self-stigma and stigmatizing behaviors among the public; however, few have considered stigma among healthcare providers, including pharmacists. This study aimed to assess the level of stigma towards mental illness, using the 15-item version of the Opening Minds Scale for Health Care Providers (OMS-HC), and associated factors among pharmacy students and was conducted via a printed questionnaire. A total of 125 students participated and the mean total stigma score was 47.9 with 58.4% of the participants scoring above 45, the midpoint of the possible range of scores. The stigma score was independent of participant demographics, except for grade point average. Higher total stigma scores were observed among subjects who have been prescribed a neuropsychiatric drug before, those who believe that pharmacists should have a role in mental healthcare, those who believe that pharmacists are qualified enough to provide mental health support, and those who are willing to seek help from a pharmacist. The results indicate an overall high stigma score among pharmacy students, which highlights the importance of enhancing pharmacy students' awareness and knowledge regarding mental healthcare through incorporating additional courses and/or training programs in pharmacy education curricula.

Attitudes, beliefs, knowledge, and practices for over-the-counter syringe sales in community pharmacies: A systematic review

BACKGROUND

Community pharmacies are an important resource for people who inject drugs (PWID) to purchase over-the-counter (OTC) syringes. Access to sterile injection equipment can reduce the transmission of blood-borne illnesses. However, pharmacists and their staff ultimately use discretion over sales.

OBJECTIVE

To identify staff attitudes, beliefs, knowledge, and practices in the sale of OTC syringes in community pharmacies.

METHODS

This systematic review was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42022363040). We systematically searched PubMed, Embase, and Scopus from inception to September 2022. The review included peer-reviewed empirical studies regarding OTC syringe sales among community pharmacy staff (pharmacists, interns, and technicians). We screened records and extracted data using a predefined data extraction form. Findings were narratively synthesized, and critical appraisal was conducted using the Mixed Methods Appraisal Tool.

RESULTS

A total of 1895 potentially relevant articles were identified, and 35 were included. Most studies (23; 63.9%) were cross-sectional descriptive designs. All studies included pharmacists, with seven (19.4%) also including technicians, two (5.6%) including interns, and four (11.1%) including other staff. Studies found relatively high support among respondents for harm reduction-related services within community pharmacies, but less common reports of staff engaging in said services themselves. When studies investigated the perceived positive or negative impacts of OTC syringe sales, prevention of blood-borne illness was widely understood as a benefit, while improper syringe disposal and safety of the pharmacy and its staff commonly reported as concerns. Stigmatizing attitudes/beliefs toward PWID were prevalent across studies.

CONCLUSION

Community pharmacy staff report knowledge regarding the benefits of OTC syringes, but personal attitudes/beliefs heavily influence decisions to engage in sales. Despite support for various syringe-related harm reduction activities, offerings of services were less likely due to concerns around PWID.

Discordance in Addressing Opioid Crisis in Rural Communities: Patient and Provider Perspectives

Providing patient-centered care to manage chronic pain and opioid use disorder (OUD) is associated with improved health outcomes. However, adopting a holistic approach to providing care is often challenging in rural communities. This study aims to identify and contrast challenges to providing patient-centered care from the perspective of patients and providers. A participatory design approach was adopted to elicit the perceptions of providers and patients with lived experiences of chronic pain and/or OUD in Jefferson County, Wisconsin. Two focus groups were conducted with each stakeholder group to identify problems that participants face with respect to chronic pain management and OUD and possible solutions. Four interviews were conducted with providers experienced in chronic pain management. Analysis of focus group sessions and interviews show consensus among patients and providers that lack of behavioral health and recovery resources create barriers to effectively manage OUD and chronic pain. However, there was discordance among the two groups about other barriers such as patient and provider attitudes, tapering approach, and access to medications for OUD. This tension among patients and providers can influence patients’ retention in therapy. More efforts are needed to mitigate stigma among providers in rural communities and support psychosocial needs of patients.

A survey of pharmacists' knowledge, attitudes and barriers in pharmaceutical care concept in Poland

BACKGROUND

The major goals of pharmaceutical care (PC) are to improve the patient's quality of life and ensure safety of pharmacotherapy. Inclusion of a pharmacist in the multidisciplinary team caring for the patient and integration of state-of-the-art pharmaceutical services with medical care and nursing are some of the most important challenges that the health care system in Poland is facing.

OBJECTIVES

To evaluate the pharmacists attitudes towards practice in, and knowledge of PC in Poland and to identify the barriers in PC provision.

METHODS

The study was designed as a multicenter study, conducted among Polish pharmacists. Random sampling technique was employed to select the study group. Face-to-face questionnaire method was used to interview the pharmacists, upon obtaining their prior verbal consent to participate in the study. The study was conducted between January 2017 and September 2019.

RESULTS

Only 15% of the pharmacists have ever attended a training on PC. 72% believed PC provision was necessary to ensure pharmacotherapy safety. Only 63% of the pharmacists believed that preventing and solving health-related and drug therapy problems for patients were their responsibilities. The main reason for non-provision of PC by the pharmacists was the lack of time for such activities, lack of legal regulations, lack of organizational facilities.

CONCLUSION

This study indicates that implementation of PC is expected in Poland. Educational programs in this respect are urgently needed. PC provision should be included in the curricula of academic pharmaceutical courses.

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure

BACKGROUND

Pharmacists' roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists' care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere.

OBJECTIVES

The aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances.

METHODS

A focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit.

RESULTS

Two rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit.

CONCLUSION

A Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.

Pharmacist furnishing of naloxone in California: A follow-up analysis

BACKGROUND

Increasing naloxone access in communities has been a priority to mitigate the increasing rate of opioid-related overdose deaths.

OBJECTIVES

The aims of this telephone survey were to estimate the availability of naloxone furnishing (provided without a prescription) by community pharmacists in California and examine the changes that occurred between 2018 and 2020.

METHODS

A telephone audit of a random representative sample of 1271 California licensed community pharmacies was conducted from January 22, 2020, to February 24, 2020. The results were compared with those of a survey of 1147 California licensed community pharmacies that was conducted from January 23, 2018, to February 28, 2018. The primary outcomes measured were naloxone availability without a prescription, information on formulations, cost, insurance billing, and stocking status.

RESULTS

There was a statistically significant increase in the furnishing of naloxone, as well as stocking and billing, in California from 2018 to 2020. Although fewer than half of the pharmacies were willing to provide naloxone without a prescription in 2020 (n = 487, 42.4%), this was an 80% increase from 2018 (P < 0.001). Of the pharmacies furnishing naloxone, many (n = 399, 81.9%) had nasal naloxone in stock, a large and statistically significant increase from 2018 when only 50.6% reported having it in stock (P < 0.001). In 2020, 90% of the pharmacies reported correctly that pharmacist-furnished naloxone could be billed to insurance compared with 56.9% in 2018 (P < 0.001). The median cash price of nasal naloxone (pack of 2) at chain pharmacies in 2020 was $131 (interquartile range [IQR] $129-$138) compared with $153 (IQR, $141-$163; P = 0.001) at independent pharmacies.

CONCLUSION

Community pharmacy-based access to naloxone increased in a statistically significant manner in California, although more than half of the pharmacies still do not provide such access. This study demonstrates the need for further efforts to expand community pharmacy-based access to naloxone.

Pharmacist Views Regarding the Prescription Opioid Epidemic

Community pharmacists have significant opportunity to contribute to prevention and treatment of opioid use disorders, but barriers to implementation still exist. Understanding their viewpoints is critical to designing future interventions. To qualitatively explore experiences and beliefs of community pharmacists regarding the misuse of prescription opioids in the United States. The study was part of a larger project that utilized a survey questionnaire to evaluate the relationships between knowledge, attitudes, and practices of community pharmacists in substance use disorders. The survey included an open-ended item on pharmacist views regarding the prescription opioid epidemic. The responses were used for inductive content analysis. Axial coding of themes was conducted to analyze underlying relationships: associations, consequences, intervening relationships, and action strategies regarding a central phenomenon. A model describing pharmacist experiences in the opioid epidemic was conceptualized. The open-ended question resulted in 50 (37.3%) usable responses. Final abstraction resulted in six themes including (1) overprescribing opioids: inappropriate prescribing as a contributor to the epidemic, (2) policy and practice recommendations: potential action strategies against the epidemic, (3) poor prescriber-pharmacist relationship: barrier to addressing the epidemic, (4) negative attitudes: intervening condition affecting roles of the pharmacist, (5) personal experience: facilitator to improve pharmacist roles and (6) decreased access to opioids: consequence of strict prescribing laws. The study identified themes that described pharmacist views, attitudes, barriers, and experiences related to their perceived role in prevention and treatment of opioid use disorders. Future research should consider the implications of the barriers and facilitators identified.