Explaining Pharmacy Students’ Dispensing Intentions in Substance Abuse-Related Gray Areas Using the Theory of Planned Behavior

Abstract

Objective. To examine the extent to which theory of planned behavior (TPB) constructs and demographic characteristics explain pharmacy students' dispensing intentions in ethically or legally gray areas involving potential substance misuse or abuse. Methods. Two cohorts of third-year Doctor of Pharmacy (PharmD) students (n5159) were provided with five written cases describing common "gray area" dispensing scenarios in community practice involving medications and devices with potential for misuse or abuse (eg, long-term buprenorphine maintenance prescription without evidence of tapering, early refill of a narcotic for an out-of-town patient, non-prescription sale of pseudoephedrine). Students completed a 12-item survey instrument for each case. Items assessed whether the student would dispense the medication or device in the given scenario, how many times in 10 similar scenarios the student would dispense the medication or device, attitudes regarding dispensing, and subjective norm and perceived behavioral control beliefs. Results. Wide variation in the percentages of students who would dispense the medications or devices was noted across the five scenarios (14% in the buprenorphine scenario to 61% in the pseudoephedrine scenario). Attitude scores significantly predicted dispensing decisions in all scenarios (p,.001), whereas subjective norm and perceived behavioral control beliefs were significant predictors of dispensing only in select case scenarios. Gender and community pharmacy work experience did not consistently predict dispensing intentions. Conclusion. Student attitudes consistently predicted intent to dispense across five gray practice scenarios. These findings can be used to inform development of educational interventions that influence students' attitudes and self-awareness in community practice decision-making scenarios involving potential substance misuse or abuse.

Article Commentary: Pharmacy: Addressing Substance use in the 21st Century

“…129,130 All pharmacists and pharmacy students should receive training to reduce or eliminate stigma in their practices to ensure all patients receive compassionate, patient-centered care from all members of the care team. 77,79,[131][132][133][134][135][136][137] Every student pharmacist should participate in an interprofessional expanded SUD curriculum integrated throughout didactic classes such as toxicology, pharmacology, pharmacotherapeutics, as well as introductory and advanced pharmacy practice experiences. 70,71,106 Naloxone and harm Table 2.…”

“…129 , 130 All pharmacists and pharmacy students should receive training to reduce or eliminate stigma in their practices to ensure all patients receive compassionate, patient-centered care from all members of the care team. 77 , 79 , 131 - 137…”

“…They study the effectiveness of innovative policy implementation, besides focusing on expanding interdisciplinary SUD education for student and practicing pharmacists. 52 , 62 , 69 - 91…”