Interprofessional Prescription Opioid Abuse Communication among Prescribers and Pharmacists: A Qualitative Analysis

Abstract

Background Prescribers and community pharmacists commonly perceive prescription opioid abuse to be a problem in their practice settings and communities. Both cohorts have expressed support for interventions that improve interprofessional communication and reduce prescription opioid abuse. The objective of this study was to describe prescription opioid abuse-related communication among and between prescribers and community pharmacists in South Central Appalachia. Methods The investigators conducted five focus groups with 35 Appalachian Research Network practice-based research network providers between February and October, 2014. Two prescriber-specific, two pharmacist-specific, and one interprofessional (prescribers and pharmacists) focus groups were conducted, recorded, and transcribed. Data collection and analysis occurred iteratively. Emerging themes were inductively derived and refined. Five member-checking interviews were conducted to validate themes. Results Providers noted several factors that influence intraprofessional and interprofessional communication, including level of trust, role perceptions, conflict history and avoidance, personal relationships, and prescription monitoring program use. Indirect communication approaches via patients, office staff, and voicemail systems were common. Direct pharmacist to prescriber and prescriber to pharmacist communication was described as rare and often perceived to be ineffective. Prescriber to pharmacist communication was reported by prescribers to have decreased after implementation of state prescription monitoring programs. Difficult or uncomfortable conversations were often avoided by providers. Conclusions Interprofessional and intraprofessional prescription opioid abuse communication is situational and influenced by multiple factors. Indirect communication and communication avoidance are common. Themes identified in this study can inform development of interventions that improve providers’ intra- and interprofessional communication skills.

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

“…The best way to ensure precise, secure, and confidential care is for pharmacists to have real-time access to all health information related to the patients’ SUD and co- morbidities. 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…”

“…The best way to ensure precise, secure, and confidential care is for pharmacists to have real-time access to all health information related to the patients' SUD and co-morbidities. 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.…”

Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin

“… 27 Qualitative research has identified some key factors influencing implementation of PDMPs such as linkage to electronic health records (EHR), 29 - 31 and communication barriers between physicians and pharmacists. 32 , 33 In addition, qualitative research has illuminated the perceived unintended consequences of the PDMP by PDMP staff, law enforcement officials, and administrative agency employees. 17 However, these studies have not focused on how implementation factors such as monitoring and enforcement vary by state or how these differences may influence the perceived unintended consequences of the PDMP.…”

Community pharmacist engagement in opioid use disorder prevention and treatment behaviors: A descriptive analysis

“…Descriptive research has shown that lack of confidence, lack of time, unwillingness to communicate with prescribers, limited familiarity with screening materials, and inability to identify patients at risk of overdose all limit pharmacist engagement with patients at risk for substance misuse. [13][14][15] Despite perceived barriers , at the point of dispensing prescription opioid analgesics (POA) and MOUD, community pharmacists are well positioned to engage patients in conversations that span all three levels of OUD prevention, and seek to optimize patient care.…”