Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states
Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states
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DOI：
10.1016/j.japh.2017.01.013
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发表时间：
2017-03-01
影响因子：
2.1
通讯作者：
Bratberg, Jeffrey
中科院分区：
文献类型：
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作者：
Green, Traci C.;Case, Patricia;Bratberg, Jeffrey
目标：我们对药剂师和消费者对药房纳洛酮的态度知之甚少。我们调查了阿片类药物使用障碍患者、长期服用阿片类药物止痛的患者、阿片类药物使用者的护理人员以及来自两个早期纳洛酮药房采用州（马萨诸塞州和罗德岛州）的药剂师对药房纳洛酮的看法和体验。 设计：2015 年 10 月至 12 月举行了 8 个焦点小组（每个州 4 个）。 背景和参与者：参与者是从药房、健康诊所和社区组织招募的；药剂师是从专业组织和药学院招募的。 结果衡量：焦点小组由经过培训的定性研究人员使用主题指南领导，并进行记录和转录以进行分析。五位分析师开发了一种编码方案并将其应用于转录本。主题分析涉及编码数据的综合和关键主题之间的联系，以及各组之间的比较。 结果：61 名参与者包括慢性疼痛患者 (n = 15)、阿片类药物使用障碍患者 (n = 19)、护理人员 (n = 16) 和药剂师 (n = 11)。大多数药剂师向患者配发纳洛酮；所有消费者参与者中有少数人获得了药房纳洛酮。出现了四个主题：消费者担心如果要求纳洛酮会产生未来后果；药剂师对纳洛酮相关实践物流的担忧；对药房如何处理阿片类药物安全性的不同看法；以及解决这些障碍的解决方案。尽管消费者群体对纳洛酮的认识和药房的供应情况存在差异，但所有群体都表示支持药剂师的作用以及基于明确标准普遍提供纳洛酮的偏好。结论：药房补充了向患者和护理人员提供的社区纳洛酮。为了克服纳洛酮收据的耻辱，需要提高公众对纳洛酮的认识，并需要对药剂师进行有关纳洛酮和成瘾的培训。药剂师应通过通用选择退出策略（即所有符合循证标准的患者都提供纳洛酮）提供纳洛酮，而不是有针对性或选择加入策略（即只有被认为高风险的患者或有要求的患者才提供纳洛酮）。 (C) 2017 年美国药剂师协会 (R)。由爱思唯尔公司出版。保留所有权利。
Objectives: Little is known about attitudes of pharmacists and consumers to pharmacy naloxone. We examined perceptions and experiences of pharmacy naloxone from people with opioid use disorder, patients taking chronic opioids for pain, caregivers of opioid users, and pharmacists from 2 early pharmacy naloxone adopter states: Massachusetts and Rhode Island.Design: Eight focus groups (4 per state) were held in October to December 2015.Setting and participants: Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges.Outcome measures: Focus groups were led by trained qualitative researchers using a topic guide, and recorded and transcribed for analysis. Five analysts developed and applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between key themes, with comparisons across the groups.Results: Sixty-one participants included patients with chronic pain (n = 15), people with opioid use disorders (n = 19), caregivers (n = 16), and pharmacists (n = 11). A majority of pharmacists had dispensed naloxone to patients; a minority of all consumer participants had obtained pharmacy naloxone. Four themes emerged: consumer fear of future consequences if requesting naloxone; pharmacists' concerns about practice logistics related to naloxone; differing perceptions of how opioid safety is addressed in the pharmacy; and solutions to addressing these barriers. Whereas consumer groups differed in awareness of naloxone and availability at pharmacies, all groups expressed support for the pharmacist's role and preferences for a universal offer of naloxone based on clear criteria.Conclusion: Pharmacies complement community naloxone provision to patients and caregivers. To overcome stigma of naloxone receipt, increased public awareness of naloxone and pharmacist training about naloxone and addiction are required. Pharmacists should offer naloxone via universal opt-out strategies-where all patients meeting evidence-based criteria are offered naloxone-rather than targeted or opt-in strategies-where only patients perceived as high risk or patients who request it are offered naloxone. (C) 2017 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.