Applying the capability, opportunity, motivation, and behavior model to identify opportunities to increase pharmacist comfort dispensing naloxone in Texas: A structural equation modeling approach

Varisco, Tyler J.; Downs, Callie G.; Rathburn, Kaycie R.; Fleming, Marc L.; Thornton, J. Douglas

doi:10.1016/j.drugpo.2020.102827

Cited by 14 publications

(8 citation statements)

References 38 publications

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“…This model states that any behaviour is dependent on the capability of an individual to perform a behaviour and available opportunities and motivation to engage in the behaviour. Both TPB and COM-B Model have been used in pharmacy research to understand and predict behaviour [35][36][37][38][39][40].…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study

et al. 2021

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Innovative dispensing products offering real-time medication intake monitoring are being developed to address medication non-adherence. However, implementation of these interventions within the workflow of a community pharmacy is unknown. The purpose of this study was to explore factors affecting implementation of a real-time adherence-monitoring, multidose-dispensing system in community pharmacies. A mixed-method study was conducted with pharmacy staff, who packaged and dispensed medications in smart multidose packages and monitored real-time medication intake via web-portal. Pharmacy staff participated in semi-structured interviews. The Technology Acceptance Model, Theory of Planned Behaviour and Capability, Opportunity, Motivation, Behaviour Model informed the interview guide. Interview transcripts were analyzed thematically and findings were mapped back to the frameworks. The usability was assessed by the System Usability Scale (SUS). Three pharmacists and one pharmacy assistant with a mean of 19 years of practice were interviewed. Three themes and 12 subthemes were generated. Themes included: pharmacy workflow factors, integration factors, and pharmacist-perceived patient factors. The mean SUS was found to be 80.63. Products with real-time adherence monitoring capabilities are valued by pharmacists. A careful assessment of infrastructure—including pharmacy workload, manpower and financial resources—is imperative for successful implementation of such interventions in a community pharmacy setting.

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Section: Theoretical Frameworkmentioning

confidence: 99%

Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study

et al. 2021

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“…Providers could be a strong influential group in enhancing patients' intention to get naloxone amid the naloxone co-prescribing policy [12]. The important role of health care professionals in supporting education about naloxone services with non-judgmental approaches to promote opioid medication safety and relieve patient fear [51][52][53], and given the lack of readiness in pharmacist to prescribe naloxone [57], interventions targeting pharmacist to improve their awareness and willingness to prescribe naloxone is also needed for patient's access to naloxone.…”

Section: Discussionmentioning

confidence: 99%

Intention to get naloxone among patients prescribed opioids for chronic pain

et al. 2022

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Background Prescription opioids have been increasingly prescribed for chronic pain while the opioid-related death rates grow. Naloxone, an opioid antagonist, is increasingly recommended in these patients, yet there is limited research that investigates the intention to get naloxone. This study aimed to investigate intention toward getting naloxone in patients prescribed opioids for chronic pain and to assess the predictive utility of the theory of reasoned action (TRA) constructs in explaining intention to get naloxone. Methods This was a cross-sectional study of a panel of U.S. adult patients prescribed opioids for chronic pain using a Qualtrics®XM survey. These patients participated in the study during February to March 2020. The online internet survey assessed the main outcome of intention to get naloxone and constructs of TRA (attitudes and subjective norms); additional measures assessed the characteristics of patients’ opioid overdose risk factors, knowledge of naloxone, and their demographics. The relationship between TRA constructs, namely, attitudes and subjective norms, and the intention variable was examined using logistic regression analyses with the intention outcome contrasted as follows: high intention (scores ≥ 5) and non-high intention (scores < 5). Results A total of 549 participants completed the survey. Most of them were female (53.01%), White or Caucasian (83.61%), non-Hispanic (87.57%) and had a mean age of 44.16 years (SD = 13.37). Of these, 167 (30.42%) had high intention to get naloxone. The TRA construct of subjective norm was significantly associated with increased likelihood of higher intentions to get naloxone (OR 3.04, 95% CI 2.50–3.70, P < 0.0001). Conclusions Our study provides empirical support of the TRA in predicting intention to get naloxone among chronic pain patients currently taking opioids. Subjective norms significantly predicted intention to get naloxone in these patients. The interventions targeting important reference groups of these patients would have greater impact on increasing intention to get naloxone in this population. Future studies should test whether theory-based interventions focusing on strengthening subjective norms increase intention to get naloxone in this population.

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“…While providers may be familiar with this patientcentered process, pharmacists may not be as aware of the level of support that new buprenorphine patients require. (24) Pharmacists stigma toward persons with opioid use disorder is well documented in both the naloxone (25,26) and syringe exchange (27,28) literature, yet little work has been done to adequately describe the relationship between pharmacists and individuals prescribed buprenorphine. Previous work, however, has demonstrated that as many as one-third of pharmacists are unwilling to even stock buprenorphine (9,29) and that much of this unwillingness may stem from a lack of knowledge of OUD treatment and a fundamental distrust of buprenorphine patients and prescribers.…”

Section: Discussionmentioning

confidence: 99%

Changes in pharmacy are associated with gaps in medication possession in individuals treated with buprenorphine

Varisco¹,

Abughosh²,

Chen³

et al. 2020

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Objective: The objective of this study was to identify the prevalence of changes in pharmacy among incident buprenorphine users and to estimate the association between a change in pharmacy and a clinically significant gap in therapy of seven-days or longer. Methods: A repeated measures, cohort design was used to assess the association between changes in pharmacy and 7-day gaps in therapy. We first identified a cohort of patients with incident buprenorphine use from the Texas Prescription Monitoring Program. We then excluded those who filled less than three-prescriptions or completed less than seven-days of pharmacotherapy. From there, we lagged each patient’s previous pharmacy forward to determine if they changed pharmacies between subsequent prescription fills. A random intercept, fixed slope mixed model with a logistic link was then used to measure the association between a change in pharmacy and a gap in therapy. Results: Of 13,189 eligible patients, 29.5% had at least one change in pharmacy and 51.5% of those did so more than once. The median time to initial change in pharmacy was 30 (IQR:13-75) days. Patients who changed pharmacies were significantly more likely to have a gap in therapy between 7 and 29 days (aOR:1.96, 95% CI=1.81-2.13).Conclusion: Patients receiving buprenorphine based MOUD change pharmacies frequently and early in treatment which leads to clinically gaps in therapy. While qualitative explanatory work is needed to understand the reasons for such frequent changes in pharmacy, pharmacists and prescribers must both work to ensure that patients have reliable access to a convenient and reliable source of buprenorphine in order to prevent changes in pharmacy.

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Applying the capability, opportunity, motivation, and behavior model to identify opportunities to increase pharmacist comfort dispensing naloxone in Texas: A structural equation modeling approach

Cited by 14 publications

References 38 publications

Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study

Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study

Intention to get naloxone among patients prescribed opioids for chronic pain

Changes in pharmacy are associated with gaps in medication possession in individuals treated with buprenorphine

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