Differences between pharmacists’ perception of counseling and practice in the era of prescription drug misuse

Abstract

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.

Naloxone Availability in Community Pharmacies, 2019

“…28 Pharmacists dispensing naloxone, with or without a prescription, should not assume that the patients have been given any proper training or counseling about its use. 19 Our study shows ndings that having a naloxone standing order in place may not be as bene cial as intended given the lack of knowledge by the people who distribute the medication.…”

“…10-13,13−18 Pharmacists are well positioned to identify patients on high opioid dosages who would bene t from having naloxone on hand, to dispense naloxone, and to counsel patients accurately on its usage and overdose signs and symptoms. 9,13,14,17,19 All 50 states have passed laws increasing access to naloxone, although speci c access conditions vary by state. 20 Forty-two states as well as the District of Columbia allow the over-the-counter purchase of naloxone without the requirement of a prescription from a primary healthcare provider.…”

“…20 Forty-two states as well as the District of Columbia allow the over-the-counter purchase of naloxone without the requirement of a prescription from a primary healthcare provider. 5,19 A 2020 study found that adequate funding and sta ng of local health departments and pharmacies, especially those in US counties with high rates of opioid overdose deaths, would be bene cial in supporting implementation of naloxone kit distribution and other opioid-related initiatives. 7 Studies in states that currently have standing orders, or orders in place that allow pharmacist to dispense naloxone to persons without prescriptions, have found a variety of availability of naloxone in chain retail community pharmacies.…”

Naloxone availability in independent community pharmacies in Georgia, 2019

“…Many studies have found that increased public awareness and increased pharmacist knowledge and training would be beneficial for increasing access to naloxone and potentially reducing opioid-related deaths [ 11 – 19 ]. Pharmacists are well positioned to identify patients on high opioid dosages who would benefit from having naloxone on hand, to dispense naloxone, and to counsel patients accurately on its usage and overdose signs and symptoms [ 10 , 14 , 15 , 18 , 20 ]. Recent policies passed by the American Pharmacists Association House of Delegates “supports access to third-party prescriptions for opioid reversal agents”; “supports the education for pharmacists … [on] the appropriate use of opioid reversal agents in overdose”; and “supports the pharmacist role in … providing education about the proper use of opioid reversal agents to prevention opioid-related deaths due to overdose.” [ 21 ]…”

“…All 50 states have mechanisms by which pharmacists can directly dispense naloxone to patients without a prescription from a physician, although specific access conditions vary by state [ 22 – 24 ]. Forty-two states as well as the District of Columbia allow the purchase of naloxone without the requirement of a prescription from a primary healthcare provider [ 5 , 20 ]. A 2020 study found that adequate funding and staffing of local health departments and pharmacies, especially those in US counties with high rates of opioid overdose deaths, would be beneficial in supporting implementation of naloxone kit distribution and other opioid-related initiatives [ 8 ].…”