Objective: This study was conducted to assess pharmacists' practices when counseling patients on their prescription medications, and their preferences for training. Methods: Five focus group discussions of community pharmacists (n=45, with seven to eleven participants in each group) were conducted in a major metropolitan city in the southern United States. Participants were recruited via email using a list of community pharmacists provided by the Texas State Board of Pharmacy. All focus group discussions were structured using a moderator guide consisting of both discrete and open-ended questions. Qualitative analysis software was used to analyze the data with a thematic analysis approach. Results: The participants in this study had a high self-efficacy regarding their ability to counsel on both new and opioid prescriptions. Many pharmacists experienced the same barriers to counseling and agreed on the components of counseling. However, the themes that emerged showed that the participants exhibited only a partial understanding of the components of counseling. The themes that emerged in the thematic analysis were perceived confidence and discordant counseling practices, inadequate infrastructure, lack of comprehensive counseling, inconsistent use of the Prescription Drug Monitoring Program (PDMP), and pharmacists' desired training/assistance. Conclusions: Community pharmacists are in a unique position to help combat the opioid crisis; however, there has been very little research on the pharmacist-patient interaction in this context. With policy changes, such as the PDMP mandate, going into effect across the country, it is important to capitalize on the potential community pharmacists have in ameliorating the opioid crisis in the United States.

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The following focused information is being presented to assist you in understanding the key elements of this study, as well as the basic reasons why you may or may not wish to consider taking part. This section is only a summary; more detailed information, including how to contact the research team for additional information or questions, follows within the remainder of this document under the "Detailed Information" heading. What should I know about a research study?Whether or not you take part is up to you. You can choose not to take part. You can agree to take part and later change your mind. Your decision will not be held against you. You can ask all the questions you want before you decide and can ask questions at any time during the survey. We invite you to take part in a research study about perceptions regarding treatment for Alcohol Use Disorder and Opioid Use Disorder. In general, your participation in the research involves the time it takes to complete this survey. This survey takes approximately 15-20 minutes to complete. Upon completion of the survey, neither the research team nor the panel provider will reach out to you for any further involvement on your part. There is no foreseeable risk to you taking this survey. The panel provider may provide you with an incentive to complete this survey, but there is no additional compensation from the research team. Your response to this survey will have the indirect beenfit of helping the research team understand potential barriers to patients seeking treatment for a Substance Use Disorder. This information will be vital to designing and implementing interventions to ease the patient burden when seeking treatment.

patient during morning ICU rounds was adopted. Finally, the programmed daily order option from the electronic health records system was removed. A reeducation lecture was held in August 2018 and partial audit data was shown. Results: From May to October 2018, all CXR images were urgently acquired, and their average time was 43 minutes from order to availability. Before intervention, the median number of CXRs per patient per day was 0.38 (0.36 -0.40). After, this amount decreased to 0.30 (0.28 -0.32) [p= 0.0013], representing a 22% reduction on CXR request. Mean length of ICU stay before and after campaign was, respectively, 8.14 (7.79 -8.71) and 8.45 (8.24 -9.74) days [p= 0.35]. Mean mortality rate before and after intervention was, respectively, 18.45% (6 3.87%) and 21.58% (6 2.23%) [p = 0.12]. Conclusions: This was the first report of a Choosing Wisely initiative in a Brazilian ICU of a public hospital. Transition to a high value on-demand CXR strategy in ICUs is safe and particularly noteworthy in a low resource public health system.