Professional impairment: a history and one state's response

Traditional and Nontraditional Collaborations to Improve Population Health Using Geospatial Information SystemMaps: Analysis of the Opioid Crisis

INTRODUCTION

The study aims were to analyze interprofessional practice collaborations among traditional and nontraditional health care providers and to educate nurse practitioner preceptors and students on population health, specifically, implementation of geospatial information system (GIS) maps and the correlation with the opioid crisis.

METHODS

A descriptive analysis was used to examine New York State data on the opioid crisis in comparison to outcome data from GIS maps of opioid use in two boroughs in New York City. Web-based modules were designed for analysis of GIS maps of opioid use near practice settings.

RESULTS

New York State data provided context for local opioiduse, while GIS maps identified specific areas of the New York City boroughs that were most affected by the opioid epidemic.

DISCUSSION

The importance of local GIS maps is that the information is available in real-time, and thus interventions can be designed, evaluated, and changed quickly to meet the immediate needs of the community.

Fitness to practise in pharmacy: a study of impairment in professional practice

OBJECTIVE

To explore the opinions and knowledge of Australian pharmacists about impairment in the profession, and their awareness of new legislation regarding impairment and mandatory reporting.

SETTING

Pharmacy practice in Australia.

METHOD

Pharmacists' opinions and knowledge were explored using a purposively designed, de-identified survey distributed by an intermediate mailing house to randomly selected pharmacists registered with the Pharmacy Board. Descriptive statistics and thematic analyses were conducted on the data. KEY OUTCOME MEASURES: This being an explorative study, we analysed various items using standard statistical methods and qualitative thematic analysis for responses to open-ended questions.

RESULTS

Responses from 370 registered pharmacists were obtained. Of these, nearly 60% were not confident in their knowledge of legislation relating to impairment. The vast majority stated they would consider reporting an impaired colleague in principle, but only after consulting the colleague. Older pharmacists demonstrated increased awareness of new legislation; this was accompanied however, by a marked decrease in confidence regarding knowledge about impairment. Thematic analysis of the qualitative data revealed four main themes: (1) perception of impairment and support systems available (2) stigma related to implications of impairment and whistle-blowing (3) factors affecting reporting of impairment and (4) management of impairment.

CONCLUSION

Australian pharmacists in this study recognised the importance of the issue of impairment, but appeared to lack confidence and/or awareness of legislative requirements regarding impairment in the profession. There is a need for educative programs and accessible, profession-specific rehabilitative programs to be instigated for management of impairment in the profession of pharmacy in Australia.

Determinants of fentanyl and other potent µ opioid agonist misuse in opioid-dependent individuals

PURPOSE

Based on preclinical and clinical abuse liability assessments, fentanyl and other potent µ opioid agonists (e.g., hydromorphone and morphine) should be the most misused opioids if accessibility in the real world were not an issue. Since the latter is seldom true, we postulated that there would be a significant mismatch between actual and predicted rates of misuse.

METHODS

We recruited 1818 prescription-opioid dependent patients entering drug treatment programs to complete an anonymous survey, covering drug use and health related issues.

RESULTS

Hydrocodone and oxycodone products were the drugs of choice in 75% of patients, whereas potent µ opioid agonists (fentanyl, hydromorphone, and morphine), with the greatest predicted abuse potential, were very rarely chosen (< 5% each). Most unexpectedly, the rank order of the actual drug of choice and the preferred drug in an ideal world were highly correlated. The reason most commonly given for the failure to endorse fentanyl, for example, as an actual or preferred drug, was fear of toxicity and overdose. We found few differences in drug use patterns between a subset of high-risk, impaired health care professionals (N = 196), and all other patients other than source of drug (forged prescriptions and doctors more common and dealers much less common in the HC sample).

CONCLUSIONS

These results indicate that it should not be assumed--particularly for new drug formulations--that a high potential for abuse will result in actual abuse; and, most importantly, that the hesitancy to use potent opioids because of fears of abuse may be misguided.