Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches
Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches
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DOI：
10.1016/j.japh.2020.03.005
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发表时间：
2020-09-01
影响因子：
2.1
通讯作者：
Bratberg, Jeffrey
中科院分区：
文献类型：
--
作者：
Green, Traci C.;Donovan, Elizabeth;Bratberg, Jeffrey
目的：药房为照料者、服用阿片类药物的患者和药物使用者提供可获得的纳洛酮来源。虽然法律允许扩大纳洛酮的使用范围，但之前的工作发现了一些障碍，比如对成瘾耻辱的担忧，以及阻碍扩大规模的时间限制。我们试图比较两个州在一年时间里在药房获得纳洛酮的异同，并探索阿片使用障碍患者、服用阿片类药物治疗慢性疼痛的患者、阿片使用者的照顾者以及药剂师对旨在促进纳洛酮摄取的沟通工具和患者外展材料的反应。设计：2016年12月至2017年4月在马萨诸塞州和罗德岛举行的八个焦点小组(FGs)。背景和参与者：参与者从药房、卫生诊所和社区组织招募；药剂师从专业组织和药学学院招募。结果：FGs由训练有素的定性研究人员领导，使用为输入而设计的主题指南和原型。五名分析师对成绩单应用了一种编码方案。主题分析包括编码数据和主题之间的联系的综合，跨组比较和第一年的发现。结果：共有56人参与：慢性疼痛服用阿片类药物的患者(n=13)，阿片类药物使用障碍的人(n=15)，照顾者(n=13)和药剂师(n=16)。对未来后果的恐惧和药房的耻辱是前一年的一个突出主题。出现了四个新的主题：提供药房纳洛酮的经验，临床医生-药剂师合作的方法，纳洛酮的共同描述，以及芬太尼作为药房纳洛酮的激励因素。提示消费者纳洛酮可用性的原型、促进纳洛酮对话的材料以及旨在解决污名的海报都受到了很好的欢迎。结论：纳洛酮的配药经历正在迅速演变，越来越多的患者正在获得药房的纳洛酮。持续存在的与污名相关的担忧突显了需要工具来帮助药剂师提供纳洛酮，方便患者的请求，并在获得纳洛酮时提供保证。(C)2020美国药剂师协会(R)。爱思唯尔公司出版，版权所有。
Objectives: Pharmacies provide accessible sources of naloxone to caregivers, patients taking opioids, and individuals using drugs. While laws permit expanded pharmacy naloxone access, prior work identified barriers like concerns about stigma of addiction and time constraints that inhibit scale-up. We sought to examine similarities and differences in experiences obtaining naloxone at the pharmacy over a 1-year period in 2 states, and to explore reactions from people with opioid use disorder, patients taking opioids for chronic pain, caregivers of opioid users, and pharmacists to communication tools and patient outreach materials designed to improve naloxone uptake.Design: Eight focus groups (FGs) held December 2016 to April 2017 in Massachusetts and Rhode Island.Setting and participants: Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges.Outcome measures: The FGs were led by trained qualitative researchers using a topic guide and prototypes designed for input. Five analysts applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between themes, with comparisons across groups and to first-year findings.Results: A total of 56 individuals participated: patients taking opioids for chronic pain (n = 13), people with opioid use disorders (n = 15), caregivers (n = 13), and pharmacists (n = 16). Fear of future consequences and stigma in the pharmacy was a prominent theme from the previous year. Four new themes emerged: experience providing pharmacy naloxone, clinician-pharmacist-partnered approaches, naloxone coprescription, and fentanyl as motivator for pharmacy naloxone. Prototypes for prompting consumers about naloxone availability, materials facilitating naloxone conversations, and posters designed to address stigma were well received.Conclusions: Experiences dispensing naloxone are quickly evolving, and a greater diversity of patients are obtaining pharmacy naloxone. Persistent stigma-related concerns underscore the need for tools to help pharmacists offer naloxone, facilitate patient requests, and provide reassurance when getting naloxone. (C) 2020 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.