Attitudinal factors associated with community pharmacists' involvement in services for drug misusers

Community Pharmacists' Knowledge and Perceptions of Buprenorphine for Patients with Opioid Use Disorder

OBJECTIVES

The aims of the study are to evaluate community pharmacists' knowledge and perceptions regarding buprenorphine for opioid use disorder and their willingness to dispense buprenorphine and to identify opportunities for education.

METHODS

An electronic survey of Michigan pharmacists (n = 11,123) assessed demographics, training, buprenorphine knowledge, dispensing, perceptions of stigma, diversion, and confidence in patient/provider interactions. Composite scores for knowledge, stigma, diversion, and confidence were calculated. Cross-tabulations and logistic regressions examined associations.

RESULTS

There were 775 surveys returned (response 7%, n = 11,123) with 390 community pharmacists completing the survey. Twenty-five percent practiced in a rural area. Common practice sites were chain or independent pharmacies (30% each). Ninety-seven percent had buprenorphine training, 50% from Accredited Continuing Pharmacy Education. Eighty percent reported that their pharmacy dispensed buprenorphine with 90% of rural pharmacists compared with 71% urban responding yes. Composite knowledge scores did not differ between urban or rural location ( P > 0.05). Predictors of willingness to dispense buprenorphine were urban location (odds ratio, OR, 0.55; 95% confidence interval [CI], 0.34-0.91; P = 0.01), independent pharmacy (OR, 0.53; 95% CI, 0.30-0.94; P = 0.03), Accredited Continuing Pharmacy Education training (OR, 0.54; 95% CI, 0.34-0.87; P = 0.01), low stigma/diversion (OR, 0.51; 95% CI, 0.37-0.70; P = 0.00), and confidence in patient/provider interactions (OR, 0.14; 95% CI, 0.10-0.19; P = 0.00).

CONCLUSIONS

Most survey pharmacists practice at pharmacies that dispense buprenorphine for opioid use disorder, with a larger proportion from rural pharmacies reporting availability. Pharmacists at independent pharmacies in urban locations have increased willingness to dispense buprenorphine, with urban pharmacists having lower perceptions of diversion compared with rural. Differences in buprenorphine availability, pharmacist willingness to dispense, and perceptions are opportunities for education. Limitations include one state, response bias, self-assessed competencies, and small samples.

Student pharmacists' attitudes, perceptions, and knowledge regarding opioid use, misuse, and overdose: Four years of data

INTRODUCTION

The American Association of Colleges of Pharmacy has urged pharmacy faculty to commit to actions to reduce the public health threat from opioid use and misuse. Optimizing student pharmacist training necessitates understanding changes in their attitudes and perceptions over time. This study assessed student attitudes, perceptions, and understanding of addiction, opioid use and misuse, and opioid overdose over four sequential years, from 2016 to 2019.

METHODS

The participants were third-professional year doctor of pharmacy students enrolled in a required course. Participants voluntarily completed a 27-statement survey to determine student attitudes, perceptions, and understanding.

RESULTS

A total of 452 participants completed the survey (response rate = 76.5%). Of the 27 survey items, five survey statements showed year on year positive increases in specific student attitudes towards addiction, hopefulness for its treatment, and confidence to use and train opioid overdose reversal agents. These yearly changes did not appear to be related to any changes in the academic aptitude of the students. The 22 remaining statements showed positive and stable attitudes towards self-perceived understanding of opioid use and misuse, hopefulness for its treatment, and the role of pharmacists.

CONCLUSION

To our knowledge, this is the first large multiyear assessment of student pharmacists' attitudes, perceptions, and understanding of opioid use, misuse, and overdose. The data indicate favorable and improving attitudes. Knowledge of student attitudes, perceptions, and understanding regarding opioid use, misuse, and overdose will aid in the development of effective training programs for students in our, and other colleges of pharmacy.

[Opioid agonist therapy and the German Narcotic Drugs Prescription Ordinance from the pharmacist's perspective]

BACKGROUND

Opioid agonist therapy (OAT) has been established to be the most important therapy option for improving health and social burdens of people with opioid dependence. Pharmacies provide drug substitutes to substitution practices or outpatient clinics and administer drugs to substituted patients (medication under visual control) or supply prescriptions for unsupervised, at-home use by patients. Given the gaps in medical care, the relevance of pharmacies for the comprehensive treatment of opioid-dependent patients will become even more important in the future. The 3^rd Revision of the Narcotic Drugs Prescription Ordinance (NDPO) adopted sweeping reforms to the framework of OAT in 2017. This paper examines the impact of this reform from the pharmacist's perspective.

METHODS

Between November 2020 and March 2021, pharmacists in the German federal states of Hamburg, North-Rhine Westphalia, Saxony, and Bavaria were informed by their State Chambers of Pharmacists about participation in this online study. A total of 480 questionnaires were evaluated. The analysis differentiates between pharmacists who are currently involved in the substitution of opioid-dependent patients (54.2%), pharmacists who were involved in the past (21.4%), and those who have never been involved in opioid substitution (24.4%).

RESULTS

Pharmacists involved in OAT have not seen any positive changes resulting from the 3^rd Revision of the NDPO. According to 97.9% of the pharmacists, remuneration for administering medication under visual control should be analogous to remuneration in doctors' practices. Mixed prescriptions (prescription of take-home dose and intermediate medication under visual control) increase the administrative workload and have been rejected by a quarter of the pharmacists. Non-involved pharmacists significantly overestimated the occurrence of critical situations with substituted patients in the pharmacy. While only 2.7% of pharmacists involved in OAT reported drug emergencies, 23.1% of non-involved pharmacists expressed such concerns. 39.3% of the pharmacists felt they could be motivated to participate in OAT if they were approached directly, and 73.9% of the pharmacists who are currently involved in OAT said they could provide substitution medication under visual control to additional opioid-dependent patients.

CONCLUSIONS

The 3^rd Revision of the NDPO has no influence on the situation and willingness of pharmacists to be involved in OAT. However, to ensure that pharmacists continue to be actively involved in OAT and attract new substituting pharmacies, their importance for comprehensive OAT must be upgraded. This includes, and not least, the funding of pharmacists' administration of substitution drugs under visual control. In addition, knowledge about OAT, attitudes toward opioid-dependent patients, and contact anxiety could be addressed by promoting educational awareness and training.

Community pharmacists' preparedness to intervene with concerns around prescription opioids: findings from a nationally representative survey

Background Prescription opioid use and related harms have dramatically increased in many countries. Objective To investigate pharmacists' preparedness and confidence to intervene when concerned about supplying prescription opioids and strategies used when concerned about supplying these opioids. Setting Online survey among a representative sample of Australian community pharmacists. Method Pharmacists completed an online survey about their concerns, comfort and strategies used when supplying prescription opioids. Correlates of comfort to intervene and active intervention strategies were explored using multivariable ordered logistic regression and adjusted odd ratios (aOR) and 95% confidence intervals were reported. Main outcome measures Comfort to intervene when concerned about supplying prescription opioids and pharmacists' discussing these concerns with the patient, and the prescriber. Results Most pharmacists were concerned about supplying prescription opioids to patients in the past week. Being female [adjusted odds ratio (aOR) 0.63; 95% confidence interval (CI) 0.47-0.85] was associated with reduced comfort, while practicing within a large chain pharmacy (aOR 1.52, 95% CI 1.08-2.15) was associated with greater comfort to intervene when concerned about prescription opioid supply. Pharmacists practicing in rural areas were significantly less likely than those in capital cities to discuss concerns with patients (aOR 0.66, 95% CI 0.45-0.97). Post-graduate education about substance use disorders was associated with increased likelihood of discussing concerns with patients (aOR 1.54, 95% CI 1.12-2.13). Pharmacists that indicated greater comfort in intervening when concerned about prescription opioids were more likely to discuss concerns with both patients and prescribers. Females were significantly more likely to discuss concerns with prescribers (aOR 1.67, 95% CI 1.22-2.29), whereas years of practice reduced the odds of discussing concerns with prescribers (aOR 0.98, 95% CI 0.97-0.99). Conclusion Considering specific factors such as gender and years of practice to help target pharmacist training may lead to increased comfort in discussing concerns related to prescription opioids, which in turn may improve communication with prescribers and patients.

Indiana community pharmacist preceptors' knowledge and perceptions of medication-assisted treatment

OBJECTIVES

The study aim was to characterize the Indiana community-based pharmacist preceptors' knowledge and perceptions of medication-assisted treatment (MAT) for opioid use disorder (OUD). The secondary objectives were to explore the desired resources, dispensing concerns, and preceptors' involvement in precepting students.

DESIGN

A 38-item survey was used to collect respondent demographics, knowledge, and perceptions of MAT for OUD. Perception questions were developed using the social cognitive theory and were adapted from previously published surveys with investigators' permission.

SETTING

Community-based Indiana pharmacist preceptors were eligible to complete an electronic survey in February and March 2019.

OUTCOME MEASURES

Descriptive statistics were used to characterize preceptor knowledge and perceptions of MAT for OUD. Desired MAT resources, dispensing concerns, and level of involvement in precepting students were collected. Respondent demographics were collected to characterize the study sample.

RESULTS

Of the 116 survey responses, 104 were eligible, and 79 community-based pharmacist preceptors completed the survey, yielding a response rate of 76.0%. For knowledge questions, the overall correct score was 56.2%. Respondents had high correct scores on questions related to medication access. However, respondents either self-identified or performed poorly on the following knowledge items: Food and Drug Administration-approved MAT products for OUD, the need to provide an opioid-free interval before initiating treatment with buprenorphine and naltrexone, pregnancy recommendations, and treatment of severe OUD. Respondents reported positive perceptions on MAT for OUD, but identified concerns regarding diversion and misuse of MAT. Most respondents reported a desire for additional education on different aspects of MAT for OUD. Dispensing concerns and preceptors' involvement with students in MAT ranged from no concern and lack of involvement to many different concerns and full student involvement.

CONCLUSION

Opportunities exist to fill identified gaps in knowledge, enhance perceptions, and provide desired continuing education for community-based pharmacist preceptors on MAT for OUD.

The attitudes and practice strategies of community pharmacists towards drug misuse management: A scoping review

WHAT IS KNOWN AND OBJECTIVE

Community pharmacists have a key role to play in addressing drug misuse. The objective of this research was to systematically review the current evidence and investigate the attitudes and practice strategies of community pharmacists towards drug misuse management.

METHODS

Data were extracted from 19 studies retrieved via a three-step search strategy using the Arksey and O'Malley methodological framework for conducting scoping reviews.

RESULTS AND DISCUSSION

The attitudes and practice strategies of pharmacists towards drug misuse management and relevance to years of practice experience were discussed in seven of the 19 studies. Pharmacists reported gaps in knowledge and insufficient education and training on drug misuse-related topics. Barriers to the effective management of drug misuse included lack of time and staff training. The most commonly reported strategy to address drug misuse was referral back to the doctor. Eight of the studies identified the benefits of real-time prescription monitoring systems. Pharmacists have a key role to play in addressing drug misuse. Opportunities exist in the development of new and innovative approaches for harm minimization led by pharmacists, and in the examination and evaluation of the pharmacists' role in referral services, interventions and screening.

WHAT IS NEW AND CONCLUSION

It is important to consider the role and contribution of early career pharmacists in the delivery of primary health care. They are the future of the pharmacy profession; therefore, it is critical that they are sufficiently trained and provided with the necessary resources to ensure high quality care in the management of drug misuse.

A Classroom Activity to Increase Student Pharmacists Confidence in Dealing with the Opioid Epidemic

Objective. To implement and assess the impact of a hybrid flipped-classroom activity designed to increase the motivation and confidence of Doctor of Pharmacy (PharmD) students in addressing the opioid crisis. Methods. Third-professional year student pharmacists were provided with reading material developed by federal agencies and professional pharmacy organizations, as well as Georgia-specific information covering medical amnesty and local resources for opioid-overdose prevention prior to class. They then attended a four-hour classroom session that included hearing a lecture on opioid pharmacology and opioid overdose, viewing training videos, and engaging in extensive discussion. The students voluntarily completed pre- and post-intervention assessments regarding opioid abuse and opioid overdose prevention. Results. Seventy of the 107 third-year students enrolled in the course completed the pre-intervention assessment (65% response rate), and 33 of the 70 completed the post-intervention assessment (47% retention rate). The students exhibited a high baseline motivation to assist in combating the opioid crises, but less confidence in their ability to intervene. Significant increases were seen in areas related to student confidence on the post-intervention assessment. Fewer changes were seen in areas related to student motivation. Conclusion. A "hybrid" flipped classroom activity increased the confidence of student pharmacists in their understanding of the physical and adverse effects of opioids and the application of reversal agents. Increased confidence may support increased intervention.

Implementing a clozapine supply service in Australian community pharmacies: barriers and facilitators

BACKGROUND

Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, although serious adverse effects such as agranulocytosis and cardiomyopathy limit its use. In July 2015, Australian regulations changed to allow community-based prescribing and supply of clozapine for maintenance therapy. However, there is currently no information on the rate of clozapine services available in Australian community pharmacies, or the factors that influence a pharmacist's decision to provide, or not provide, a clozapine service, particularly from the perspective of those pharmacists who do not offer this service. This study investigated Australian community pharmacies providing a clozapine supply service and the barriers to, and facilitators of, implementing this service.

METHODS

This mixed method exploratory study was conducted in two stages: (1) a brief online survey of community pharmacists Australia-wide; and (2) semi-structured telephone interviews. The survey was conducted between November 2017-January 2018; results were analysed via descriptive statistics. Survey respondents who did not provide a clozapine service were eligible to participate in a telephone interview exploring barriers and facilitators. Interviews were undertaken between December 2017-January 2018 and data analysed thematically.

RESULTS

A total of 265 pharmacists completed the survey; 51.3% (n = 136) provided a clozapine service. Consumer demand was a key facilitator (n = 18/247; 66.1%) and the main barrier to implementing a clozapine service was a perceived lack of need (n = 70/122; 57.4%). Twelve survey respondents were interviewed; while most participants acknowledged that supplying clozapine in community pharmacies would benefit consumers due to convenience, the lack of training and support led to difficulties in service implementation.

CONCLUSIONS

Although regulatory changes aimed to improve access to clozapine, it is unclear if they have been successful, or to what degree. Community pharmacists were positive about supplying clozapine in the community but identified a need for training and support to raise awareness of the service so that eligible clozapine consumers can be transitioned to community-based care. Further research is needed about the perceptions of clozapine consumers to determine whether the regulatory changes have resulted in positive outcomes for their independence and quality of life.

Pharmacists' attitudes and practices about selling syringes to people who inject drugs in Tajikistan: Results of a syringe purchase audit and a survey

BACKGROUND

In Tajikistan, governmental policies leave the decision whether or not to sell syringes to people who inject drugs (PWID) to pharmacists' discretion. This exploratory study tests a theory-driven model explaining Tajikistani pharmacists' actual syringe sale practices to inform future HIV advocacy activities.

METHODS

Data were collected via attempts to purchase syringes without prescription and a subsequent survey among a sample of 232 pharmacists in two cities (Dushanbe and Kulob) in Tajikistan in 2015. The survey collected data on attitudes and beliefs related to selling syringes to PWID, stigma against PWID and background contextual factors such as social conservatism, HIV and drug use knowledge. Structural equation modelling was used to assess the relationships between syringe sale practice and pharmacists' attitudinal and background factors.

RESULTS

The majority (87.9%, n = 204) of sampled pharmacists agreed to sell syringes to the study research assistants without a prescription. According to the final model, agreeing to sell syringes was moderately associated with the reported intent to provide syringes without prescription (β = 0.36, p < 0.001), lower stigma against PWID (β=-0.43, p = 0.01), and stronger social conservatism (β = 0.35, p = 0.02). Intent to provide syringes correlated with positive attitudes towards provision of syringes (β = 0.35, p = 0.008), which in turn were negatively associated with stigma (β=-0.54, p < 0.001) and positively with age (β = 0.20, p = 0.03). Stigma against PWID was directly associated with social conservatism (β = 0.47, p < 0.001) and inversely with university-level education (β=-0.28, p < 0.001).

CONCLUSION

We demonstrated the accessibility of over-the-counter syringes in urban pharmacies of Tajikistan and emphasized the role of stigma in shaping pharmacists' syringe sale practices. Advocacy interventions should target pharmacists to reduce stigmatization of PWID and ensure access to clean syringes.

Why aren't Australian pharmacists supplying naloxone? Findings from a qualitative study

BACKGROUND

Opioid overdose is a significant public health issue among people who use pharmaceutical opioids and/or heroin. One response to reducing overdose deaths is to expand public access to naloxone. The Australian Therapeutic Goods Administration down-scheduled naloxone from prescription only (S4) to pharmacist only over-the-counter (OTC, schedule 3) in February 2016. There is little research examining pharmacists' perspectives or experiences of this change.

METHODS

Thirty-seven semi-structured interviews with Australian community pharmacists were conducted in 2016-2017 to investigate pharmacists' attitudes to and experiences of OTC naloxone. Transcripts were thematically analysed, guided by a broad interest in facilitators and barriers to OTC supply.

RESULTS

Around half of the pharmacists were aware of the down-scheduling and only two had provided OTC naloxone. Core barriers to pharmacist provision of OTC naloxone included limited understanding of opioid overdose, confusion about the role and responsibilities of pharmacists in providing OTC naloxone, concerns about business, stigma related to people who inject drugs (PWID) and system-level challenges.

CONCLUSION

Pharmacy provision of OTC naloxone offers an important opportunity to reduce overdose mortality. Our study suggests this opportunity is yet to be realised and highlights several individual- and structural-level impediments hindering the expansion of public access to naloxone via community pharmacies. There is a need to develop strategies to improve pharmacists' knowledge of OTC naloxone and opioid overdose as well as to address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. These need to be addressed at the individual level (training) as well as the system level (information, regulation and supply).

Stigmatization of people who inject drugs (PWID) by pharmacists in Tajikistan: sociocultural context and implications for a pharmacy-based prevention approach

Background

Pharmacies are an important source of sterile syringes for people who inject drugs (PWID) in Tajikistan who are under high risk of HIV and hepatitis C virus. Accessibility of sterile syringes at pharmacies without prescription may depend on pharmacists’ attitudes towards PWID. This qualitative inquiry examines meanings and processes of stigmatization of PWID among pharmacists and pharmacy students in Tajikistan.

Methods

We conducted semi-structured interviews with 19 pharmacists and 9 students (N = 28) in the cities of Dushanbe and Kulob, Tajikistan. The interview topics included personal attitudes towards drug use and PWID, encounters with PWID, awareness and beliefs related to drug dependence and HIV, and attitudes and practices related to providing syringes to PWID. Interview transcripts were analysed using thematic analysis methods.

Results

The main themes included the significance of religion in defining attitudes towards drug use, labelling of PWID, negative stereotypes (PWID are prone to crime, violence, and irrational aggression; inflict harm to families and society; are able to control drug use), emotions triggered by PWID (fear, sympathy) and discrimination against PWID (rejection, isolation, ostracism, limiting resources to PWID). The religious ban on drug use and pharmacists’ moral and legal responsibility for the consequences of drug use were frequently mentioned as reasons for rejecting syringe sales. Still, many participants acknowledged the need for distributing syringes to PWID to prevent HIV.

Conclusions

Stigma against PWID in Tajikistan plays an important role in shaping pharmacists’ attitudes towards provision of services to this population. Local sociocultural context, in particular religious beliefs and social conservatism, may facilitate stigmatizing beliefs.

Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdose reversal

AIM

Given the potential to expand naloxone supply through community pharmacy, the aim of this study was to estimate Australian pharmacists': (1) level of support for overdose prevention, (2) barriers and facilitators for naloxone supply and (3) knowledge about naloxone administration.

DESIGN

Online survey from nationally representative sample of community pharmacies.

SETTING

Australia, September-November 2015.

PARTICIPANTS

A total of 1317 community pharmacists were invited to participate with 595 responses (45.1%).

MEASUREMENTS

We assessed attitudes towards harm reduction, support for overdose prevention, attitudes and knowledge about naloxone. We tested the association between attitudes towards harm reduction and different aspects of naloxone supply.

FINDINGS

Pharmacists were willing to receive training about naloxone (n = 479, 80.5%) and provide naloxone with a prescription (n = 537, 90.3%). Fewer (n = 234, 40.8%) were willing to supply naloxone over-the-counter. Positive attitudes towards harm reduction were associated with greater willingness to supply naloxone with a prescription [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.11-1.19] and over-the-counter (OR = 1.13, 95% CI = 1.09-1.17). Few pharmacists were confident they could identify appropriate patients (n = 203, 34.1%) and educate them on overdose and naloxone use (n = 190, 31.9%). Mean naloxone knowledge scores were 1.8 (standard deviation 1.7) out of 5. More than half the sample identified lack of time, training, knowledge and reimbursement as potential barriers for naloxone provision.

CONCLUSION

Community pharmacists in Australia appear to be willing to supply naloxone. Low levels of knowledge about naloxone pharmacology and administration highlight the importance of training pharmacists about overdose prevention.

A Scenario-Based Virtual Patient Program to Support Substance Misuse Education

Objective. To evaluate virtual patient (VP) programs for injecting equipment provision (IEP) and opiate substitution therapy (OST) services with respect to confidence and knowledge among preregistration pharmacist trainees. Methods. Preregistration trainee pharmacists pilot-tested the VP programs and were invited to complete pre/post and 6-month assessments of knowledge and perceived confidence. Results. One hundred six trainees participated and completed the pre/postassessments. Forty-six (43.4%) participants repeated the assessments at six months. Scores in perceived confidence increased in all domains at both time points postprogram. Knowledge scores were greater posteducation than preeducation. Knowledge scores were also greater six months after education than preeducation. Knowledge scores at six months were lower than posteducation for both programs. Conclusion. Virtual patients programs increased preregistration pharmacists' knowledge and confidence with regard to IEP and OST immediately after use and at six months postprogram. There was a loss of clinical knowledge over time but confidence change was sustained.

Pharmacists' different profiles characterization about opioid substitution treatments

INTRODUCTION

Delivering practices of opioid substitution treatment (OST) in community pharmacies are heterogeneous. This study aims at drawing up an inventory and at characterizing different populations of pharmacists, regarding their practices and perceptions.

METHODS

We distributed a questionnaire to pharmacists, which was divided into two parts: socio-demographic questions, and 49 binary questions collecting pharmacists' perceptions. Statistical analyses were performed using SAS 9.3 and SPAD7 software. The categorical variables were expressed as numbers and percentages. We characterized the different profiles of pharmacists using a multivariate analysis method.

RESULTS

We analyzed 303 questionnaires; 60.8% of our cross-section of pharmacists consider that OSTs are a treatment for chronic disease, a treatment in which they consider that they play a key role. Regarding OSTs, 89.3% felt "comfortable" with current regulations, while 77.3% have mastered possible interactions with other drugs. 16.8% of pharmacists equate the act of delivering OSTs as a "legal narcotic deal". Regarding the patients, 49.2% of pharmacists consider them as "different", and 39.1% fear that they cause relationship problems. Most pharmacists perceive the role they are meant to play, although a lack of training and the need for recommendations have been highlighted. PCA allowed us to characterize 4 different profiles of pharmacists.

CONCLUSION

Continuous training adapted to the different profiles we drew up will be offered in order to allow pharmacists to deepen their knowledge about drug dependence and related care support.

A cross-sectional study of the feasibility of pharmacy-delivered harm reduction services among people who inject drugs in Xichang, China

Background

HIV prevalence is high in Liangshan, China (1.1 %). In 2012, people who inject drugs (PWID) in Xichang, the capital city, contributed to 60.0 % of the HIV infections. The goal of the current study was to examine the feasibility of implementing pharmacy-delivered harm reduction services (PDHRS) for PWID.

Methods

Face-to-face structured interviews with 403 PWID included questions on PWID’s experiences of syringe services and their specific experiences, acceptance, and potential usage of PDHRS.

Results

There were some reports of harassment/bad treatment from pharmacists (12.2 %) and police (17.6 %). Non-prescription syringe sales (NPSS) from pharmacies in single piece were the main source (82.1 %) of syringes. 72.5 % of PWID reported visiting 31.5 % of the identified pharmacies. Most (74.7 %) PWID disposed of their used syringes by throwing them away. Only one PWID brought used syringes back to a pharmacy in the past 30 days. Half of the PDHRS, such as printed materials about HIV, Hepatitis C and STIs; risk reduction services; (16.9 %) and sharps container to dispose of syringes (0.2 %) were offered by a few pharmacies (<20 % for each service). The acceptance rates among PWID toward currently offered services were high (≥91.1 %). All potential PDHRS were acceptable by most (68–95.3 %) PWID, and correspondingly 67–94.5 % of PWID reported they would use each service if offered.

Conclusions

NPSS from pharmacies provided many PWID in Liangshan with new syringes. However, disposal of used syringes was problematic. At the time of investigation, half of 16 assessed PDHRS were already available in pharmacies in Xichang. PWID were ready to use all the potential PDHRS and14 of 16 PDHRS were feasible to provide. HIV testing kits may be available in pharmacies in the future. Many pharmacy-delivered harm reduction services are feasible and acceptable among PWID in Xichang, China.

Reality and feasibility for pharmacy-delivered services for people who inject drugs in Xichang, China: Comparisons between pharmacy staff and people who inject drugs

BACKGROUND

In 2010, the reported overall HIV prevalence in Liangshan China (1.14%) was 19.7 times of the overall estimated prevalence in China (0.058%), and injection drug use contributed to 60.0% of overall HIV infections in Xichang, the Capital city of Liangshan. With one national methadone clinic and three outpatient service sites, and three NEP sites, the HIV prevalence among people who inject drugs (PWID) in Xichang was estimated as 18.0% (2.8 times of national HIV prevalence among PWID) in 2012.

METHODS

Face-to-face questionnaire interviews were used in a cross-sectional study to assess experience, attitudes, possibility and acceptability of implementing 8 pharmacy-delivered services among PWID (n=403). The concordance of attitudes, possibility and acceptability between PWID and pharmacy staff (n=50) was examined.

RESULTS

Rather than medical facility (23.1%), and NEP (8.9%), pharmacies were the main source of syringes for PWID in the last 12 months (82.1%), PWID (63.5%) reported syringes could be bought in single piece and at the price of $0.16 USD (59.3%). In the last 30 days, only 1 PWID brought used syringes back to a pharmacy. Pharmacy staff's attitudes were generally negative but nearly neutral (average score -0.18), discrimination/business concerns against pharmacy-delivered services existed, and 4 of 5 compared attitude questions between PWID and pharmacy staff were statistically different (p<0.01). 5 of 8 pharmacy-delivered services were available for PWID at low level (≤16.9%). Pharmacy staff's supportive perception for pharmacy-delivered services focused on pharmacies' initiate roles targeting on general population more than on PWID. PWID were more supportive and optimistic than pharmacy staff toward potential usage of pharmacy-delivered services (p<0.05).

CONCLUSION

Pharmacy-delivered services for PWID in Xichang were partly in reality, and could be feasible. It is urgently needed to address the legal requirements and remuneration for pharmacies. Pharmacy staff should receive additional training on services related knowledge and skills, cultural sensitivity toward PWID. Successful pharmacy-delivered services would benefit from identifying mutual interest and benefit between pharmacies and PWID.

Contested space in the pharmacy: public attitudes to pharmacy harm reduction services in the West of Scotland

BACKGROUND

Internationally, community pharmacies have become increasingly involved in providing harm reduction services and health advice to people who use illicit drugs.

OBJECTIVE

This paper considers public opinion of community pharmacy services. It discusses attitudes to harm reduction services in the context of stigmatization of addiction and people who use drugs.

METHODS

This exploratory study involved twenty-six purposively sampled members of the public, from the West of Scotland, participating in one of 5 focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, none of whom were problem drug users.

RESULTS

Three thematic categories were identified: methadone service users in community pharmacies; attitudes to harm reduction policies; contested space. Harm reduction service expansion has resulted in a high volume of drug users in and around some Scottish pharmacies. Even if harm reduction services are provided discretely users' behavior can differentiate them from other pharmacy users. Drug users' behavior in this setting is commonly perceived to be unacceptable and can deter other consumers from using pharmacy services. The results of this study infer that negative public opinion is highly suggestive of stereotyping and stigmatization of people who use drugs. Participants considered that (1) community pharmacies were unsuitable environments for harm reduction service provision, as they are used by older people and those with children; (2) current drug policy is perceived as ineffective, as abstinence is seldom achieved and methadone was reported to be re-sold; (3) people who use drugs were avoided where possible in community pharmacies.

CONCLUSIONS

Community pharmacy harm reduction services increasingly bring together the public and drug users. Study participants were reluctant to share pharmacy facilities with drug users. This paper concludes by suggesting mechanisms to minimize stigmatization.

First insights into community pharmacy based buprenorphine-naloxone dispensing in Finland

BACKGROUND

Finnish community pharmacies have been permitted to dispense buprenorphine-naloxone since February 2008. This study explored the dispensing practices, service experiences, problems encountered and opportunities for future development.

METHODS

In August 2011, a questionnaire was mailed to all Finnish community pharmacies dispensing buprenorphine-naloxone (n=69).

RESULTS

Sixty-four pharmacies responded (93%), of which 54 had dispensed buprenorphine-naloxone to 155 clients since 2008. Forty-eight pharmacies had 108 current clients (10% of all buprenorphine-naloxone clients in Finland). Overall satisfaction with buprenorphine-naloxone dispensing was high, with all respondents indicating dispensing had gone 'well' or 'very well'. Fourteen pharmacies (26%) had experienced one or more problems, predominately in relation timing or non-collection of doses. Problems were more common in pharmacies with more than one buprenorphine-naloxone client (odds ratio 1.39, 95% confidence interval 1.05-1.86). Most pharmacies (n=43, 80%) identified opportunities for improvement, including the need for more education and financial remuneration. Forty-six pharmacies (85%) were willing to dispense buprenorphine-naloxone to more clients; however, 43 pharmacies (80%) perceived that supervision of buprenorphine-naloxone dosing is not a suitable task for pharmacists in Finland.

CONCLUSION

Provision of buprenorphine-naloxone in Finnish community pharmacies has remained relatively small-scale. As experiences have been generally positive and problems rare, it may be possible to expand these services.

Provision of opioid substitution therapy services in Australian pharmacies

Opioid dependence, despite being the subject of significant public funding, remains a costly burden to Australian society in human and economic terms. The most cost-effective public health strategy for managing opioid dependence is opioid substitution therapy (OST), primarily through the use of methadone or buprenorphine. Supervised dispensing of OST from specialist clinics and community pharmacies plays a crucial role in enhancing compliance, monitoring treatment and reducing diversion. Australia, compared with other countries in the world, ranks very high in illicit opioid use; hence there is a great demand for OST.The utilisation of community pharmacies for stable patients has many advantages. For public clinics, patient transfer to community pharmacies relieves workload and costs, and increases capacity for new OST patients. From a patient's perspective, dosing at a pharmacy is more flexible and generally more preferable. Pharmacists stand to gain clientele, profit and receive small incentives from state governments in Australia, for their services. Yet, many "unmet needs" exist and there is a high demand for more involvement in OST service provision in community pharmacy in Australia.In the UK there has been a steady increase in community pharmacy provision of OST, and pharmacists appear ready to provide further healthcare services to these patients.The role of pharmacy in some countries in Europe, such as Germany, is less prominent due to their approach to harm minimisation and the complex, variable nature of OST provision across the European Union (EU). The provision of OST by pharmacists in the USA on the other hand is of lesser frequency as the healthcare system in the USA encourages detoxification clinics to handle cases of illicit drug addiction.At a time when harm minimisation strategies constitute a topic of considerable political and public interest, it is important to understand the scope and variability of pharmacy involvement in drug policy in Australia. Hence, this review highlights the role of pharmacists in OST and explores the scope for expanding this role in the future.

Motivations for and barriers to community pharmacy services for drug misusers

Objective

To investigate what motivated pharmacists to provide drug misuse services and, conversely, what barriers prevented service provision.

Method

Telephone interviews were conducted with a purposive sample of 45 volunteering respondents to a national questionnaire survey to gain in-depth information.

Setting

Forty-five community pharmacists in Scotland.

Key findings

Pharmacists were found to be motivated to provide services by an awareness of the needs of the community, a desire to reduce the spread of blood-borne diseases and a desire to expand their professional services. Barriers to service provision were concerns for the effect on other customers, safety, workload and poor remuneration.

Conclusion

The active encouragement of local health boards, professional endorsement, further education and remuneration might encourage pharmacists' participation in drug misuse services. This would enable the principles of harm reduction to be widely practised.

Role of Service Providers of Needle Syringe Program in Preventing HIV/AIDS

To provide a national-scale picture of the needle exchange program in Taiwan, this study examined (a) needle and syringe program (NSP) service providers' AIDS-relevant harm reduction knowledge and attitudes; and (b) NSP services schemes and operation barriers encountered by different service modalities. A self-administrated questionnaire was mailed to all participating NSP service providers in Taiwan. A total of 414 service providers completed the postal survey. This study confirms that NSP service providers play an essential role in providing comprehensive activities to reduce HIV/AIDS infection for drug misusers. Knowledge and attitudes of service providers were found to be independently and important predictors of NSP service provisions. Community-based and clinical-based providers had diverse service schemes and encountered operation problems due to different organization characteristics, professional training, and ethical concern. For the future planning of NSP programs, service-specific education and professional support are essential component of service delivery and quality.

Impact of supervision of methadone consumption on deaths related to methadone overdose (1993-2008): analyses using OD4 index in England and Scotland

OBJECTIVE

To evaluate the impact of introduction of supervision of methadone dosing on deaths related to overdose of methadone in Scotland and England between 1993 and 2008 while controlling for increased prescribing of methadone.

DESIGN

Analysis of annual trends in deaths related to overdose of methadone in relation to defined daily doses of methadone prescribed.

SETTING

Scotland and England. Population Deaths in which methadone was coded as the only drug involved or as one of the drugs implicated.

MAIN OUTCOME MEASURE

Annual OD4-methadone index (number of deaths with methadone implicated per million defined daily doses of methadone prescribed in that year).

RESULTS

OD4-methadone declined substantially over the four epochs of four years between 1993 and 2008. It decreased significantly (P<0.05) in 10 of 12 epoch changes: in Scotland from 19.3 (95% confidence interval 15 to 24) to 4.1 (2.8 to 5.4) and finally to 3.0 (2.4 to 3.5) for methadone only deaths (and from 58 to 29 to 14 for deaths with any mention of methadone); in England from 27.1 (25 to 29) to 24.8 (23 to 27) and finally to 5.8 (5.3 to 6.3) for methadone only deaths (and from 46 to 42 to 12 for deaths with any mention of methadone). The decreases in OD4-methadone were closely related to the introduction of supervised dosing of methadone in both countries, first in Scotland (1995-2000) and later in England (1999-2005). These declines occurred over periods of substantial increases in prescribing of methadone (18-fold increase in defined daily doses per million population annually in Scotland and sevenfold increase in England).

CONCLUSIONS

Introduction of supervised methadone dosing was followed by substantial declines in deaths related to overdose of methadone in both Scotland and England. OD4-methadone index analyses, controlled for substantial increases in methadone prescribing in both countries, identified at least a fourfold reduction in deaths due to methadone related overdose per defined daily dose (OD4-methadone) over this period.

Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment

BACKGROUND

In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes.

METHODS

This study was a cross-sectional multicentre study. Norwegian OMT staff (n = 140) were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres.

RESULTS

All invited staff (n = 140) participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings). In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate.

CONCLUSIONS

This study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.

Barriers to the provision of needle-exchange services: a qualitative study in community pharmacies

Objective

To investigate the attitudes of pharmacists to the provision of needle-exchange services (NES) at community pharmacies and, if barriers exist, explore means by which they may be overcome.

Setting

Twenty-one community pharmacies across Grampian in North East Scotland during May and June 2005.

Method

Semi-structured face-to-face interviews conducted with 24 pharmacists.

Key findings

Newly identified barriers included the negative influence of security staff, a local policy against NES provision and a lack of awareness of other services available for drug users.

Conclusion

Training packages for all health professionals working with drug users and awareness training for security staff are required if the identified barriers are to be overcome. ‘Hands-on’ training and experience of NES for pharmacists and their staff should be available. Suggestions made by pharmacists for NES provision in general practitioner surgeries or community hospitals and the development of automated services should be considered.

A pharmacist-led information and advice service based within a voluntary sector drugs service

Objectives

To explore the role of an information pharmacist within a voluntary sector drugs service, to establish a pharmacist-led information and advice service within the drugs service and to describe the nature of the use of the pharmacist's service.

Method

An intervention study.

Setting

A voluntary sector drug dependency agency in Aberdeen, UK.

Key findings

The pharmacist service was utilised by staff and service users, making 77 contacts and processing 87 enquiries in 26 weeks. Forty-five of the contacts were with agency staff and 32 were with agency service users. The nature of the 87 enquiries was analysed and defined by 11 distinct categories. These are described in the paper.

Conclusions

Pharmacists are increasingly specialising in drug misuse as members of addictions teams, but no study of information provision in this capacity could be found. The success of this service highlights the important role pharmacists can play in providing information and advice to professionals and drug misusers. It also supports the expansion of the pharmacist's role as part of the multidisciplinary team within the voluntary sector.

South Australian rural community pharmacists and the provision of methadone, buprenorphine and injecting equipment

Objective

To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia.

Setting

Rural South Australia.

Method

Analysis of data obtained from earlier focus-group interviews enabled compilation of key issues for the development of a semi-structured questionnaire. Fifty-one potential participants were contacted. Twenty-five rural South Australian community pharmacists were interviewed through a 15–20-min semi-structured telephone questionnaire. Interview responses were manually recorded. Thematic analysis of the transcribed data by one researcher enabled determination of key issues.

Key findings

Fifty-one potential pharmacies were contacted and 25 pharmacists were interviewed. All 25 pharmacists had experience in the provision of OST services, 22 sold sterile injecting equipment and 10 offered needle exchange. Exploration of service issues in the context of rural pharmacy practice found that the geographical closeness of a small community may improve rapport with local prescribers, as indicated by 15 of 25 pharmacists. Access to other allied health services was described by 13 of the 25 as difficult. Servicing OST clients can have a negative impact on pharmacy business, is not profitable for rural pharmacies and only seven of the 25 felt adequately remunerated for the provision of their services. Client debt was an identified issue and the practice of withholding doses because of lack of payment was supported by 10 participants and not supported by an equal number. Mentored practice was highlighted as a potential area for future training, as was managing clients' debts. In addition, pharmacy structural changes to provide a private dosing area would preserve confidentiality during supervised dosing.

Conclusion

Access to allied health services in regional areas could be better coordinated. Financial incentives for South Australian pharmacies, without increasing the cost of treatment for clients, requires further exploration.

Exploring the dissonance between business and public health policy: pharmacy and the provision of opioid pharmacotherapies and clean needles in rural settings

Objective

To ascertain, by interview of rural community pharmacists, how well public health policies relating to the provision of clean needles and opioid pharmacotherapies fit with the imperatives of business. Previous research investigating the provision of opioid pharmacotherapies focused predominantly on metropolitan community pharmacists and their experience with servicing methadone clients. Furthermore, there had been no exploration as to whether dissonance exists between community pharmacy business imperatives and the public health policy underpinning these programmes.

Method

Fifteen rural community pharmacists were interviewed in three focus groups. Experienced interviewer and researcher EH facilitated all three focus group interviews. The questioning path was developed following review of the literature. Thematic analysis identified common themes and issues within the qualitative data collected.

Setting

All three focus group interviews were conducted in rural South Australia.

Key findings

Professional obligation played a key role in motivating rural community pharmacists to be involved with service provision. Dissonance existed between the sense of fulfilment by participating in a major public health initiative and the recognition of the mainly negative financial impacts. Financial gain was limited, due to difficulty in fee collection, and inadequate remuneration. Other difficulties included lack of support from allied health services, and restricted access to training due to geographical isolation.

Conclusion

Some of the difficulties experienced in the servicing of opioid-dependent clients and its clash with business imperatives are universal and not specific to a rural environment. For the provision of opioid pharmacotherapy services to have fruitful business outcomes and simultaneously deliver effective services, appropriate remuneration and support programmes are needed. Future initiatives should aim at improving pharmacist communications with allied health services and prescribing doctors, as well as greater training opportunities to address problems associated with geographical isolation. Training on realistic outcomes of opioid treatment, the philosophy of treatment, and whether the role should include reducing client doses to assist clients become ‘drug free’ were identified as relevant training issues.

Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, Australia

AIMS

To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers.

DESIGN

ross-sectional postal survey.

SETTING

All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia.

PARTICIPANTS

Completed questionnaires were received from 669 pharmacists (68% response rate).

MEASUREMENTS

The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers.

FINDINGS

In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or > or issed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001).

CONCLUSIONS

This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers.

Pharmacy support staff involvement in, and attitudes towards, pharmacy-based services for drug misusers

Objective

This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training.

Methods

The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate-keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants.

Key findings

Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three-fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One-third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three-quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services.

Conclusions

Pharmacy support staff were involved extensively in drug-misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange.

Should pharmacists have a role in harm reduction services for IDUs? A qualitative study in Tallinn, Estonia

Despite the high number of injecting drug users (IDUs) in Estonia, little is known about involving pharmacies into human immunodeficiency virus (HIV) prevention activities and potential barriers. Similarly, in other Eastern European countries, there is a need for additional sources for clean syringes besides syringe exchange programmes (SEPs), but data on current practices relating to pharmacists' role in harm reduction strategies is scant. Involving pharmacies is especially important for several reasons: they have extended hours of operation and convenient locations compared to SEPs, may provide access for IDUs who have avoided SEPs, and are a trusted health resource in the community. We conducted a series of focus groups with pharmacists and IDUs in Tallinn, Estonia, to explore their attitudes toward the role of pharmacists in HIV prevention activities for IDUs. Many, but not all, pharmacists reported a readiness to sell syringes to IDUs to help prevent HIV transmission. However, negative attitudes toward IDUs in general and syringe sales to them specifically were identified as important factors restricting such sales. The idea of free distribution of clean syringes or other injecting equipment and disposal of used syringes in pharmacies elicited strong resistance. IDUs stated that pharmacies were convenient for acquiring syringes due to their extended opening hours and local distribution. IDUs were positive toward pharmacies, although they were aware of stigma from pharmacists and other customers. They also emphasized the need for distilled water and other injection paraphernalia. In conclusion, there are no formal or legislative obstacles for providing HIV prevention services for IDUs at pharmacies. Addressing negative attitudes through educational courses and involving pharmacists willing to be public health educators in high drug use areas would improve access for HIV prevention services for IDUs.

Comparison of injecting drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia

BACKGROUND

Both syringe exchange programs (SEPs) and pharmacy sales of syringes are available in Estonia, though the current high incidence and high prevalence of HIV among injection drug users (IDUs) in Tallinn, Estonia requires large-scale implementation of additional harm reduction programs as a matter of great urgency. The aims of this report were to compare risk behavior and HIV infection and to assess the prevention needs among IDUs who primarily use pharmacies as their source of sterile syringes with IDUs who primarily use SEPs in Tallinn.

METHODS

A cross-sectional study using respondent-driven sampling was used to recruit 350 IDUs for an interviewer-administered survey and HIV testing. IDUs were categorized into two groups based on their self-reported main source for syringes within the last six months. Odds ratios with 95% CI were used to compare characteristics and risk factors between the groups.

RESULTS

The main sources of sterile needles for injection drug users were SEP/SEP outreach (59%) and pharmacies (41%). There were no differences in age, age at injection drug use initiation, the main drug used or experiencing overdoses. Those IDUs using pharmacies as a main source of sterile needles had lower odds for being infected with either HIV (AOR 0.54 95% CI 0.33-0.87) or HCV (AOR 0.10 95% CI 0.02-0.50), had close to twice the odds of reporting more than one sexual partner within the previous 12 months (AOR 1.88 95% CI 1.17-3.04) and engaging in casual sexual relationships (AOR 2.09 95% CI 1.24-3.53) in the last six months.

CONCLUSION

The data suggest that the pharmacy users were at a less "advanced" stage of their injection career and had lower HIV prevalence than SEP users. This suggests that pharmacies could be utilized as a site for providing additional HIV prevention messages, services for IDUs and in linking IDUs with existing harm reduction services.

Consumer satisfaction with opioid treatment services at community pharmacies in Australia

OBJECTIVE

To explore consumer satisfaction with, and experiences of, a range of issues associated with the delivery of opioid substitution treatment at community pharmacies in New South Wales, Australia.

SETTING

50 community pharmacies providing opioid substitution treatment in New South Wales.

METHOD

Self-completion survey completed by 508 clients during supervised dosing.

MAIN OUTCOME MEASURE

Satisfaction with opioid substitution treatment delivery at community pharmacies.

RESULTS

Sixty-one percent of participants reported being satisfied with their treatment programme. Participants expressed a high level of satisfaction with most aspects of opioid substitution treatment delivery at their pharmacy (aggregate mean = 8.1/10; 10 = excellent). However, participants were less satisfied with the level of privacy afforded at the pharmacy. Thirty-four percent reported that they were made to wait longer than other customers, and 25% reported that the pharmacy staff did not treat them the same as other customers. However, 87% reported that they felt welcomed by the pharmacy staff. Twenty-three percent of clients were currently in debt to the pharmacy for nonpayment of dispensing fees. The mean amount of current debt was $71.75, equivalent to approximately 2 weeks of pharmacy dispensing fees.

CONCLUSION

Community pharmacies providing opioid substitution treatment in New South Wales appear to be providing a level of service that is satisfactory to the clients of those services. However, many participants were concerned about a lack of privacy, the high cost of treatment, and being treated differently to other customers.

Screening and brief interventions for alcohol: attitudes, knowledge and experience of community pharmacists in Auckland, New Zealand

INTRODUCTION

Screening and brief intervention (SBI) for alcohol consumption in primary care have been shown to be effective in reducing drinking. This role has not been taken up by community pharmacists. This study aimed to explore attitudes, knowledge, barriers and incentives towards involvement of community pharmacists in New Zealand with problem drinkers.

METHOD

A postal survey (three mailshots) of community pharmacies was undertaken in Auckland, New Zealand, followed by a 10% random sample non-responder-follow-up.

RESULTS

A response rate of 39.1% to the postal survey was obtained. In general, knowledge of alcohol content of drinks and recommended safe drinking limits was poor. Respondents were generally well motivated towards undertaking this role, but lacked knowledge, skills and confidence. On follow-up, non-responders were found to be less knowledgeable, but had similar attitudes to respondents, indicating potential for extrapolation with regard to beliefs and views on this subject.

DISCUSSION

This novel study has found that there is potential for involvement of community pharmacists in New Zealand in SBI for problem drinkers. Lack of knowledge can be remedied relatively easily; greater hurdles such as lack of skills, and lack of confidence may be offset by the high level of motivation of this group. This is an area where community pharmacists can further their professional scope of practice by being in an essential position to provide this service.