Opioid overdose counseling and prescribing of naloxone in rural community pharmacies: A pilot study

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

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Long-Term Effects of Opioid Overdose Prevention and Response Training on Medical Student Knowledge and Attitudes Toward Opioid Overdose: A Pilot Study

Addictive Behaviors ◽

10.1016/j.addbeh.2021.107172 ◽

2021 ◽

pp. 107172

Author(s):

Tabitha E.H. Moses ◽

Jody S. Chou ◽

Jessica L. Moreno ◽

Leslie H. Lundahl ◽

Eva Waineo ◽

...

Keyword(s):

Medical Student ◽

Pilot Study ◽

Opioid Overdose ◽

Long Term Effects ◽

Student Knowledge ◽

Overdose Prevention ◽

Knowledge And Attitudes ◽

Response Training

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Migraine Headache in a Rural Community in Nigeria: Results of a Pilot Study

Neuroepidemiology ◽

10.1159/000110687 ◽

1982 ◽

Vol 1 (1) ◽

pp. 31-39 ◽

Cited By ~ 23

Author(s):

B.O. Osuntokun ◽

Bruce S. Schoenberg ◽

V. Nottidge ◽

A. Adeuja ◽

O. Kale ◽

...

Keyword(s):

Pilot Study ◽

Rural Community ◽

Migraine Headache

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Characteristics of unmet demand for pharmacists: A survey of rural community pharmacies in Wisconsin

Journal of the American Pharmacists Association ◽

10.1331/japha.2008.07039 ◽

2008 ◽

Vol 48 (5) ◽

pp. 598-609 ◽

Cited By ~ 10

Author(s):

Abhijit S. Gadkari ◽

David A. Mott ◽

David H. Kreling ◽

Joseph K. Bonnarens

Keyword(s):

Rural Community ◽

Community Pharmacies ◽

Unmet Demand

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A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: study protocol

Pilot and Feasibility Studies ◽

10.1186/s40814-019-0506-6 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

D. E. Patton ◽

J. J. Francis ◽

E. Clark ◽

F. Smith ◽

C. A. Cadogan ◽

...

Keyword(s):

Pilot Study ◽

Process Evaluation ◽

Behaviour Change ◽

Older Patients ◽

Controlled Trial ◽

Theoretical Domains Framework ◽

Self Report ◽

Community Pharmacies ◽

Behaviour Change Techniques ◽

Limited Effectiveness

Abstract Background Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory (‘a systematic way of understanding events or situations’) can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3–4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient’s underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention’s mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients’ adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration This study is registered at ISRCTN: 10.1186/ISRCTN73831533

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COVID‐19: How Can Rural Community Pharmacies Respond to the Outbreak?

The Journal of Rural Health ◽

10.1111/jrh.12439 ◽

2020 ◽

Vol 37 (1) ◽

pp. 153-155 ◽

Cited By ~ 3

Author(s):

Georges Adunlin ◽

Pilar Z. Murphy ◽

Melanie Manis

Keyword(s):

Rural Community ◽

Community Pharmacies

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Factors Used in Multiple-Relationship Ethical Decisions in a Small University Town

Ethical Human Psychology and Psychiatry ◽

10.1891/ehpp-d-19-00019 ◽

2020 ◽

Vol 22 (1) ◽

pp. 6-18

Author(s):

Pooja D. Saraff ◽

Carolyn M. Pepper

Keyword(s):

Decision Making ◽

Pilot Study ◽

Rural Community ◽

Ethical Standards ◽

Multiple Relationships ◽

Professional Relationship ◽

Ethical Decisions ◽

University Town ◽

Decision Making Model

APA Ethical Standards for psychologists strongly caution against multiple relationships between professionals and clients to prevent exploitation; but clear guidelines are lacking. This dilemma is more common in smaller communities and this pilot study explored this issue in a small rural community using Gottlieb's (1993) decision-making model as a framework. Local practitioners (n = 25) were surveyed about their experience and factors used to make decisions regarding multiple relationships using vignettes. Majority chose to proceed with the secondary relationship citing importance of factors such as role incompatibility, clarity of termination of the professional relationship, and the availability of other professionals. Discrepancies were noted between factors rated as important and their actual influence on decisions made, which should be explored.

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