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

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Counseling, Prescription Drug Misuse, Professional Practice, Pharmacies, Pharmacists, Prescription Drug Monitoring Programs, Opioid Epidemic, Focus Groups, Texas


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.

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1. United States Department of Health and Human Services. What is the U.S. Opioid Epidemic? https://www.hhs.gov/opioids/about-the-epidemic/index.html (accessed Oct 2, 2018).
2. Centers for Disease Control and Prevention (CDC). U.S. Opioid Prescribing Rate Maps. https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html (accessed Aug 28, 2019).
3. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths - United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;64(50-51):1378-1382. https://doi.org/10.15585/mmwr.mm6450a3
4. Substance Abuse and Mental Health Services Administration. Results from the 2006 National Survey on Drug Use and Health: National Findings National Clearinghouse for Alcohol and Drug Information https://www.asipp.org/documents/2006NSDUH.pdf (accessed Aug 28, 2019).
5. National Center for Health Statistics. Drug Poisoning Mortality: United States, 1999-2015. Centers for Disease Control and Prevention. County Estimates- 2015 Web site. https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/ (accessed Apr 12, 2017).
6. Secretary Price Announces HHS Strategy for Fighting Opioid Crisis [press release]. Atlanta, GA: National Rx Drug Abuse and Heroin Summit, April 19, 2017.
7. Agency for Healthcare Research and Quality. Special Emphasis Notice (SEN): AHRQ announces interest in health services research to address the opioids crisis. https://grants.nih.gov/grants/guide/notice-files/NOT-HS-18-015.html (accessed Oct 2, 2018).
8. Thornton JD, Lyvers E, Scott VG, Dwibedi N. Pharmacists' readiness to provide naloxone in community pharmacies in West Virginia. J Am Pharm Assoc (2003). 2017;57(2S):S12-S18. https://doi.org/10.1016/j.japh.2016.12.070
9. Kelly DV, Young S, Phillips L, Clark D. Patient attitudes regarding the role of the pharmacist and interest in expanded pharmacist services. Can Pharm J (Ott). 2014;147(4):239-247. https://doi.org/10.1177/1715163514535731
10. Anderson C, Blenkinsopp A, Armstrong M. Feedback from community pharmacy users on the contribution of community pharmacy to improving the public's health: a systematic review of the peer reviewed and non-peer reviewed literature 1990-2002. Health Expect. 2004;7(3):191-202. https://doi.org/10.1111/j.1369-7625.2004.00274.x
11. Tsuyuki RT, Beahm NP, Okada H, Al Hamarneh YN. Pharmacists as accessible primary health care providers: Review of the evidence. Can Pharm J (Ott). 2018;151(1):4-5. https://doi.org/10.1177/1715163517745517
12. Texas State Board of Pharmacy. Health Professions: pharmacy and pharmacists: general provisions. In: State of Texas, 3th ed. Vol 3.J.551.262013.
13. Omnibus Budget Reconciliation Act of 1990. Statutes at Large. 104 Stat. 1388.
14. Texas State Board of Pharmacy. Texas Prescription Monitoring Program. Texas State Board of Pharmacy,. https://www.pharmacy.texas.gov/pmp/ (accessed Aug 15, 2019).
15. Norwood CW, Wright ER. Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment. Res Social Adm Pharm. 2016;12(2):257-266. https://doi.org/10.1016/j.sapharm.2015.05.008
16. Perrone J, Nelson LS. Medication Reconciliation for Controlled Substances — An “Ideal” Prescription-Drug Monitoring Program. N Engl J Med. 2012;366(25):2341-2343. https://doi.org/10.1056/NEJMp1204493
17. Goodin A, Blumenschein K, Freeman PR, Talbert J. Consumer/patient encounters with prescription drug monitoring programs: evidence from a Medicaid population. Pain Physician. 2012;15(3 Suppl):ES169-E175.
18. Norwood CW, Wright ER. Promoting consistent use of prescription drug monitoring programs (PDMP) in outpatient pharmacies: Removing administrative barriers and increasing awareness of Rx drug abuse. Res Social Adm Pharm. 2016;12(3):509-514. https://doi.org/10.1016/j.sapharm.2015.07.008
19. Wixson SE, Talbert J, Blumenschein K, Freeman PR. PHP93 Impact of Prescription Monitoring Programs on Pharmacists' Controlled Substance Dispensing Behavior. Value Health. 2012;15(4):A29-A30. https://doi.org/10.1016/j.jval.2012.03.169
20. Fleming ML, Bapat SS, Varisco TJ. Using the theory of planned behavior to investigate community pharmacists' beliefs regarding engaging patients about prescription drug misuse. Res Social Adm Pharm. 2019;15(8):992-999. https://doi.org/10.1016/j.sapharm.2018.10.027
21. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
22. Atlas.ti [computer program]. Version 7. Berlin, Germany.
23. Hartung DM, Hall J, Haverly SN, Cameron D, Alley L, Hildebran C, O'Kane N, Cohen D. Pharmacists’ role in opioid safety: a focus group investigation. Pain Med. 2018;19(9):1799-1806. https://doi.org/10.1093/pm/pnx139
24. Varisco TJ, Fleming ML, Bapat SS, Wanat MA, Thornton D. Health care practitioner counseling encourages disposal of unused opioid medications. J Am Pharm Assoc (2003). 2019;59(6):809-815. https://doi.org/10.1016/j.japh.2019.07.010
25. Pharmacists' role in addressing opioid abuse, addiction, and diversion. J Am Pharm Assoc (2003). 2014;54(1):e5-e15. https://doi.org/10.1331/JAPhA.2014.13101
26. American Society of Health System Pharmacists. ASHP statement on the pharmacist’s role in substance abuse prevention, education, and assistance. Am J Health Syst Pharm. 2014;71(3):243-246. https://doi.org/10.2146/sp140002
27. Leong C, Sareen J, Enns MW, Bolton J, Alessi-Severini S. Community pharmacy practice barriers in preventing drug misuse, divergence and overdose: a focus group study. Healthc Q. 2015;18(3):28-33. https://doi.org/10.12927/hcq.2015.24434

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