What predicts pharmacists’ engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy

Abstract

Background Pharmacists have a key role to play in identifying and responding to emerging clinical problems with prescribed opioids. A pilot study in Australia examined the implementation of screening and brief intervention (Routine Opioid Outcome Monitoring [ROOM]) to identify and respond to opioid-related problems in community pharmacies. In this implementation study, the rate of screening varied considerably between pharmacies. Objective The aim of this study was to examine pharmacist characteristics associated with implementation of ROOM. Setting Community pharmacies in Victoria and New South Wales, Australia. Methods We implemented a validated computer-facilitated screening (ROOM), combined with brief intervention for opioid-related problems based on a widely accepted framework for monitoring outcomes. In this analysis, we examined the correlates of ROOM completion for individual pharmacists. Negative binomial regression was used to identify baseline predictors of greater screening, with the number of ROOM screens as the dependent (outcome) variable and pharmacist demographics, knowledge, confidence and comfort responding to prescription opioids problems, and attitudes towards evidence based practice examined as independent (predictor) variables. Main outcome measure Number of screens completed by an individual pharmacist as reported in follow-up surveys by pharmacist. Results Fewer years of practice was associated with a greater number of screenings conducted. On average, each additional decade of practice was associated with a 31% (95% CI 0%, 53%) reduction in the number of screenings undertaken by pharmacists. A multivariable analysis revealed that each additional decade practicing, lower knowledge of naloxone and lower confidence in identifying unmanaged pain were all independently associated with reduced engagement in screening after controlling for other variables. Conclusion Findings from this pilot study identified potential barriers to implementing opioid outcome monitoring. Further studies could test different groups of community pharmacists’ experience of different barriers when implementing monitoring outcomes with prescribed opioids, to inform future implementation and clinical practice.

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Acknowledgements

The initial ROOM screening tool was developed with support from Central and Eastern Sydney Primary Health Network. We wish to acknowledge the pharmacists and pharmacy customers that contributed to the pilot implementation-effectiveness study, and members of the Adivsory Commitee for the study.

Funding

This work is supported by a Mindgardens Seedfunding Grant (UNSW) and a grant from WentWest. SN and SL are recipients of NHMRC Research Fellowships (#1163961, #1136944). We also acknowledge contributions from Victorian Pharmacotherapy Area Based Networks of Latrobe Community Health Service, Hume Area Pharmacotherapy Network—Primary Care Connect, Area Four Pharmacotherapy Network, Orticare Grampians Loddon Mallee Pharmacotherapy Network, Western Victoria PHN and Co-Health towards software development costs. The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund. The contents of the published material are solely the responsibility of the authors and do not reflect the funding bodies.

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Correspondence to Suzanne Nielsen.

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SN and SL are named investigators on untied educational grants from Indivior which are unrelated to this work. SN has received honoraria for providing training on identification and treatment of codeine dependence (Indivior). RB was a named investigator on an untied education grant from Mundipharma to conduct post-marketing surveillance on oxycodone. SN is a named investigator on research grants from Seqirus unrelated to this work.

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Nielsen, S., Sanfilippo, P., Picco, L. et al. What predicts pharmacists’ engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy. Int J Clin Pharm (2020). https://doi.org/10.1007/s11096-020-01074-5

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Keywords

  • Community pharmacy
  • Implementation
  • Opioids
  • Overdose
  • Naloxone
  • Pharmacy practice
  • Australia