Exploration of pharmacist comfort with harm reduction behaviors: Cross-sectional latent class analysis

Agley, Jon; Meyerson, Beth E.; Eldridge, Lori; Crosby, Rick; Bentele, Keith Gunnar; Jun, Mi-Kyoung; Vadiei, Nina; Kennedy, Amy; Anderson, Kirsten M.

doi:10.1016/j.japh.2021.10.015

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…In some populations, patients interact with their pharmacists more often than with their primary care physicians [22], and pharmacists have been identified as some of the most accessible health care providers in the United States [23,24]. Studies show that community pharmacists generally acknowledge their role in assisting in harm reduction [25][26][27], and an Arizona study found that community pharmacists were typically comfortable providing consultation around and dispensing naloxone, even when they were uncomfortable with other harm reduction approaches such as syringe dispensing without a prescription [28]. As such, community pharmacists are theoretically well-positioned to improve harm reduction education and accessibility of related supplies.…”

Section: Introductionmentioning

confidence: 99%

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report

Eldridge,

Meyerson,

Agley

2024

JMIR Form Res

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Background The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies’ ubiquity and pharmacists’ extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education. Objective In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team’s control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the “file-drawer” (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors’ hypotheses. Methods This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies. Results Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive. Conclusions Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study. International Registered Report Identifier (IRRID) RR2-10.2196/42373

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Section: Introductionmentioning

confidence: 99%

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report

Eldridge,

Meyerson,

Agley

2024

JMIR Form Res

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“…Comfort with multiple harm reduction practices, as used in our prior study to explore harm reduction latent classes [ 27 ]; and…”

Section: Methodsmentioning

confidence: 99%

“…In addition to their accessibility, pharmacies increasingly are perceived as effective venues for both clinical and nonclinical harm reduction owing to pharmacists’ expertise in fields such as medication management and pharmaceutical education [ 25 , 26 ]. A study of Arizona pharmacists found that even when uncomfortable with most forms of harm reduction, pharmacists were generally comfortable with dispensing naloxone [ 27 ]. In Indiana, qualitative data from managing pharmacists found conceptual support for harm reduction but, simultaneously, concerns about systemic barriers to implementation, including a lack of time for interventions as well as concerns about role clarity and patients’ expectations of what should happen in a pharmacy [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…The PharmNet team conducted numerous information gathering, feasibility, and methodological studies in preparation for the single-site pilot to obtain increasingly specific information and context, including both quantitative and qualitative work. Much of this work was conducted in conjunction with academic and community-based pharmacists and involved data collection from hundreds of managing pharmacists in 2 states [ 27 , 28 , 34 - 42 ]. The single-site pilot itself was informed by independent community pharmacists at a more granular level to maximize likely acceptability and feasibility [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

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The PharmNet Harm Reduction Intervention for Community Pharmacies: Protocol for a Pilot Randomized Controlled Trial

et al. 2022

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Background The overdose epidemic in the United States has continued to worsen despite substantial efforts to mitigate its harms. The opioid antagonist naloxone has been identified as a key means of reducing the prevalence of fatal overdoses. An important evidence-based approach to optimizing naloxone’s impact is to seed it throughout the community, because bystanders are often able to reverse overdoses more quickly than first responders and sometimes are the only possible means of overdose reversal. As part of a multipronged approach to distributing naloxone nationwide, community pharmacies have been identified as ideal venues for naloxone dispensing, especially under standing orders. However, dispensing rates remain surprisingly low, and there is a need to understand how best to engage community pharmacies in naloxone-based harm reduction services. Objective The objective of this trial is to determine whether a tailored, pragmatic pharmacy intervention (PharmNet) results in greater naloxone dispensing relative to baseline (the prior 3 months) compared to a control condition. This pilot trial is intended to determine whether it is appropriate to invest the substantial resources that would be required to conduct a full-scale, randomized controlled study of PharmNet. Methods We will conduct a 3-month randomized controlled pilot trial consisting of 2 parallel groups with a 4:3 allocation ratio. A group of 7 independent pharmacies from rural areas in Indiana will be randomly assigned to either the PharmNet intervention arm (n=4) or the control arm (n=3). The primary outcome will be overall naloxone dispensing (both at cost and free), and secondary outcomes will include the distribution of referral cards and multiple variables at the level of individual staff members. Dispensing data will be collected for the 3 months prior to the intervention and the 3 months of the intervention, and all other data will be collected using a pretest-posttest design. The primary analysis will be a generalized linear mixed model with a Poisson distribution with fixed effects for group, time, and their interaction and a random effect for pharmacy ID to account for repeated measures within pharmacies. Results This study was approved by the Indiana University institutional review board in 2 phases (August 2, 2021, and April 26, 2022) and was funded by the Indiana University Grand Challenge: Responding to the Addictions Crisis. Conclusions If this study produces evidence that the PharmNet intervention results in increased naloxone dispensing relative to control pharmacies, it will be both appropriate and important to study it in a large, full-scale randomized controlled trial. International Registered Report Identifier (IRRID) PRR1-10.2196/42373

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“…Additionally, updating counseling knowledge is important for understanding drug-related concerns such as non-adherence, adverse reactions, and misuse [ 7 – 10 ]. Pharmacists are responsible for drug therapy as they can avoid and manage drug-related problems by obtaining intensive and continuous education and training [ 11 – 13 ]. They must have a unique knowledge base to make better decisions about the treatment of patients and educate them before and during treatment [ 14 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Pharmacists' knowledge of drug food administration and their appropriate patient counseling a cross-sectional study from Palestine

Abualhasan,

Tahan,

Nassar

et al. 2023

J Health Popul Nutr

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Pharmacists have a responsibility in the treatment of patients. Interactions between food and drugs may lead to a loss of therapeutic effectiveness or drug toxicity. Our study's objectives were to assess pharmacists' knowledge of patient counseling with regard to informing the patient about taking the drug in relation to food, as well as community pharmacists' knowledge of any pharmaceutical instructions that must be given to patients when delivering the drug. The pharmacists were assessed using an interview questionnaire. The results showed a variation in the pharmacist's knowledge about the administration of the drug with food. The chief pharmacists had better knowledge of the proper food administration counseling than that of assistant pharmacists; the percentage of those who did not give the proper food counseling was 24 vs. 58%, respectively (P < 0.05). Only (21%) of pharmacists with more work experience provided proper counseling, while only 18.2 and 18.7% of pharmacists with moderate and low work experience provided proper counseling, respectively. The study showed the pharmacists’ limited knowledge of drug administration with food and outdated counseling information. It is highly recommended that a continuous education system be encouraged and enforced by the ministry of health to update pharmacist’s knowledge of dispensed drugs.

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Exploration of pharmacist comfort with harm reduction behaviors: Cross-sectional latent class analysis

Cited by 12 publications

References 35 publications

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report

The PharmNet Harm Reduction Intervention for Community Pharmacies: Protocol for a Pilot Randomized Controlled Trial

Pharmacists' knowledge of drug food administration and their appropriate patient counseling a cross-sectional study from Palestine

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