Barriers and facilitators to dispensing of intranasal naloxone by pharmacists
Barriers and facilitators to dispensing of intranasal naloxone by pharmacists
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DOI：
10.1080/08897077.2017.1391924
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发表时间：
2018-01-01
期刊：
影响因子：
3.5
通讯作者：
Cruz, Theresa H.
中科院分区：
文献类型：
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作者：
Bakhireva, Ludmila N.;Bautista, Adriana;Cruz, Theresa H.
背景资料：虽然处方类阿片滥用已达到流行病的程度，但以药店为基础的防治这一流行病的预防服务有限。本研究的目的是确定新墨西哥州药剂师分配鼻内纳洛酮（INN）的障碍和促进因素。研究方法：对于这种混合方法的研究，定性成分（焦点小组）告知定量成分（电子调查）的发展，分发给所有药剂师注册与新墨西哥州药学委员会和执业状态。一项46项调查包括关于药剂师对INN配药的担忧、INN配药的障碍和促进因素、增加药剂师配药INN的可用性和利用率所需的努力以及受访者及其药房的特征。结果如下：来自所有地理区域和所有类型的药房环境的药剂师都在样本中得到了代表（最终N = 390，参与率23.5%，包括182名社区药剂师的子集）。查明的主要障碍是：（1）患者的自付费用;（2）药剂师的时间限制;（3）药剂师的报销不足。主要促进因素是：（1）提高阿片类药物使用患者和家庭成员对INN必要性的认识;（2）对公众进行额外教育;（3）对药剂师进行额外培训，指导他们如何与高风险患者讨论INN。一些社区药剂师担心INN配药会促进阿片类药物滥用（16.5%）并吸引不良客户（14.3%）。在对社区药房亚组的多变量logistic回归分析中，对INN的更多关注（比值比[OR] = 0.87; 95%置信区间[CI]：0.82-0.93）和连锁杂货店或“大盒子”商店的药房设置（OR = 0.38; 95% CI：0.16-0.92）与分配INN的几率降低相关。结论：增加药剂师鼻内纳洛酮分配的有效干预策略应关注药剂师的关注点，包括对多个受众的教育，并解决提供者层面、系统层面和社会层面的障碍。
Background: Although misuse of prescription opioids has reached epidemic proportions, pharmacy-based preventive services to combat this epidemic are limited. The aims of this study were to identify barriers and facilitators to the dispensing of intranasal naloxone (INN) by pharmacists in New Mexico. Methods: For this mixed-methods study, a qualitative component (focus group) informed the development of a quantitative component (electronic survey) distributed to all pharmacists registered with the New Mexico Board of Pharmacy and practicing in the state. A 46-item survey included questions about pharmacists' concerns regarding dispensing INN, barriers and facilitators to dispensing INN, efforts needed to increase availability and utilization of pharmacist-dispensed INN, and characteristics of respondents and their pharmacies. Results: Pharmacists from all geographical regions and all types of pharmacy settings were represented in the sample (final N = 390, participation rate 23.5%, including a subset of 182 community pharmacists). The main barriers identified were (1) out-of-pocket costs for patients; (2) time constraints for pharmacists; and (3) inadequate reimbursement for pharmacists. The main facilitators were (1) increased awareness among opioid-using patients and family members about the need for INN; (2) additional education to the general public; and (3) additional training for pharmacists on how to initiate discussions about INN with high-risk patients. Some community pharmacists were concerned that INN dispensing would promote opioid abuse (16.5%) and attract undesirable clientele (14.3%). In a multivariable logistic regression analysis of a community pharmacy subset, a higher number of concerns about INN (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.82-0.93) and a pharmacy setting in a chain grocery or a "big box" store (OR = 0.38; 95% CI: 0.16-0.92) were associated with decreased odds of dispensing INN. Conclusions: Effective intervention strategies for increasing dispensing of intranasal naloxone by pharmacists should focus on pharmacists' concerns, include education to multiple audiences, and address provider-level, system-level, and society-level barriers.