‘We’re just seen as people that give out the methadone…’: exploring the role of community pharmacists in the opioid substitution treatment team
Rebecca Lukey 1 2 , Ben Gray 1 , Caroline Morris 1
+ Author Affiliations
- Author Affiliations
1 Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
2 Corresponding author. Email: rjlukey@gmail.com
Journal of Primary Health Care 12(4) 358-367 https://doi.org/10.1071/HC20108
Published: 22 December 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: People receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions.
AIM: To explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team.
METHODS: Semi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach.
RESULTS: This study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team.
DISCUSSION: Collaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients’ mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team’s recognition of a pharmacist’s role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.
Keywords: Pharmacy services; drug addiction; mental health; primary health care
References
[1] Montgomery Sardar C, Gibson L, Lowrie R. Risk factors for mortality, hospitalisation and imprisonment in substance misuse patients. Clin Pharm. 2018; 10| Risk factors for mortality, hospitalisation and imprisonment in substance misuse patients.Crossref | GoogleScholarGoogle Scholar |
[2] World Health Organization. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO; 2009.
[3] Connock M, Juarez-Garcia A, Jowett S, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007; 11 1–171.
| Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation.Crossref | GoogleScholarGoogle Scholar | 17313907PubMed |
[4] Sordo L, Barrio G, Bravo M, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017; 357 j1550
| Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.Crossref | GoogleScholarGoogle Scholar | 28446428PubMed |
[5] Adamson SJ, Deering DE, Sellman JD, et al. An estimation of the prevalence of opioid dependence in New Zealand. Int J Drug Policy. 2012; 23 87–9.
| An estimation of the prevalence of opioid dependence in New Zealand.Crossref | GoogleScholarGoogle Scholar | 21696937PubMed |
[6] Ministry of Health. New Zealand Practice Guidelines for Opioid Substitution Treatment. Wellington: Ministry of Health; 2014.
[7] Ministry of Health. Office of the Director of Mental Health and Addiction Services: Annual Report 2017. Wellington: Ministry of Health; 2019.
[8] Pharmacy Council of New Zealand. Pharmacy Council New Zealand, Workforce Demographic. Wellington: Pharmacy Council of New Zealand; 2018.
[9] Harrison J, Carroll T, Medlicott NJ, et al. Service provision in the wake of a new funding model for community pharmacy. BMC Health Serv Res. 2018; 18 307
| Service provision in the wake of a new funding model for community pharmacy.Crossref | GoogleScholarGoogle Scholar | 29716610PubMed |
[10] Te Pou o Te Whakaaro Nui. The physical health of people with a serious mental illness and/or addiction: An evidence review. Auckland: Te Pou o te Whakaaro Nui; 2014.
[11] Robertson HD, Bond C, Matheson C. The evolution of pharmaceutical care for drug misusers. Fam Pract. 2015; 32 cmv079
| The evolution of pharmaceutical care for drug misusers.Crossref | GoogleScholarGoogle Scholar | 26502811PubMed |
[12] Yadav R, Taylor D, Taylor G, Scott J. Community pharmacists’ role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice. Int J Clin Pharm. 2019; 41 470–7.
| Community pharmacists’ role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice.Crossref | GoogleScholarGoogle Scholar | 30771145PubMed |
[13] Matheson C, Bond CM, Tinelli M. Community pharmacy harm reduction services for drug misusers: national service delivery and professional attitude development over a decade in Scotland. J Public Health (Oxf). 2007; 29 350–7.
| Community pharmacy harm reduction services for drug misusers: national service delivery and professional attitude development over a decade in Scotland.Crossref | GoogleScholarGoogle Scholar |
[14] Matheson C, Thiruvothiyur M, Robertson H, Bond C. Community pharmacy services for people with drug problems over two decades in Scotland: implications for future development. Int J Drug Policy. 2016; 27 105–12.
| Community pharmacy services for people with drug problems over two decades in Scotland: implications for future development.Crossref | GoogleScholarGoogle Scholar | 26723885PubMed |
[15] Lawrinson P, Roche A, Terao H, Le P-P. Dispensing opioid substitution treatment: practices, attitudes and intentions of community-based pharmacists. Drug Alcohol Rev. 2008; 27 47–53.
| Dispensing opioid substitution treatment: practices, attitudes and intentions of community-based pharmacists.Crossref | GoogleScholarGoogle Scholar | 18034381PubMed |
[16] Winstock AR, Lea T, Sheridan J. Prevalence of diversion and injection of methadone and buprenorphine among clients receiving opioid treatment at community pharmacies in New South Wales, Australia. Int J Drug Policy. 2008; 19 450–8.
| Prevalence of diversion and injection of methadone and buprenorphine among clients receiving opioid treatment at community pharmacies in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar | 18359216PubMed |
[17] Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006; 18 59–82.
| How many interviews are enough? An experiment with data saturation and variability.Crossref | GoogleScholarGoogle Scholar |
[18] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
[19] Hassali MA, Nazir S, Saleem F, Masood I. Literature review: pharmacists’ interventions to improve control and management in type 2 diabetes mellitus. Altern Ther Health Med. 2015; 21 28–35.
| 25599430PubMed |
[20] World Health Organization. Primary Health care: now more than ever. The World Health Report. Geneva: WHO; 2008.
[21] Ministry of Health. Pharmacy Action Plan: 2016 to 2020. Wellington: Ministry of Health; 2016.
[22] Le PP, Braunack-Mayer A, Laurence C. Collaborative pharmacist prescribing within the opioid substitution treatment program in South Australia: patient and pharmacist views. Res Social Adm Pharm. 2018; 14 187–95.
| Collaborative pharmacist prescribing within the opioid substitution treatment program in South Australia: patient and pharmacist views.Crossref | GoogleScholarGoogle Scholar | 28325527PubMed |
[23] Mossialos E, Courtin E, Naci H, et al. From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015; 119 628–39.
| From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management.Crossref | GoogleScholarGoogle Scholar | 25747809PubMed |
[24] Shaw J, Harrison J, Harrison J. A community pharmacist-led anticoagulation management service: attitudes towards a new collaborative model of care in New Zealand. Int J Pharm Pract. 2014; 22 397–406.
| A community pharmacist-led anticoagulation management service: attitudes towards a new collaborative model of care in New Zealand.Crossref | GoogleScholarGoogle Scholar | 24612135PubMed |
[25] Hindi AMK, Schafheutle EI, Jacobs S. Community pharmacy integration within the primary care pathway for people with long-term conditions: a focus group study of patients’, pharmacists’ and GPs’ experiences and expectations. BMC Fam Pract. 2019; 20 26
| Community pharmacy integration within the primary care pathway for people with long-term conditions: a focus group study of patients’, pharmacists’ and GPs’ experiences and expectations.Crossref | GoogleScholarGoogle Scholar | 30736732PubMed |
[26] Matheson C, Liddell D, Hamilton E, Wallace J. Older people with drug problems in Scotland: a mixed methods study exploring health and social support needs. Glasgow: Scottish Drugs Forum; 2017.
[27] Ministry of Health. Service delivery for people with co-existing mental health and addiction problems. Integrated Solutions. Wellington: Ministry of Health; 2010.
[28] Ministry of Health. New Zealand Health Strategy: future direction. Wellington: Ministry of Health; 2016.
[29] Ministry of Health. Mental Health and Addiction Workforce Action Plan 2017–2021 (2nd edn). Wellington: Ministry of Health; 2018.
[30] Ministry of Health. Specialist Opioid Substitution Treatment (OST) Service Audit and Review Tool. Wellington: Ministry of Health; 2014.
[31] Winstock AR, Lea T, Sheridan J. Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, Australia. Addiction. 2010; 105 335–42.
| Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, Australia.Crossref | GoogleScholarGoogle Scholar | 20078490PubMed |
[32] McDonough R, Doucette W. Developing collaborative working relationships between pharmacists and physicians. J Am Pharm Assoc. 2001; 41 682–92.
| Developing collaborative working relationships between pharmacists and physicians.Crossref | GoogleScholarGoogle Scholar |
[33] Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential characteristics of physician/pharmacist collaborative relationships. Ann Pharmacother. 2004; 38 764–70.
| Influential characteristics of physician/pharmacist collaborative relationships.Crossref | GoogleScholarGoogle Scholar | 15031418PubMed |
[34] Doucette WR, Nevins J, McDonough RP. Factors affecting collaborative care between pharmacists and physicians. Res Social Adm Pharm. 2005; 1 565–78.
| Factors affecting collaborative care between pharmacists and physicians.Crossref | GoogleScholarGoogle Scholar | 17138496PubMed |
[35] Bollen A, Harrison R, Aslani P, van Haastregt JCM. Factors influencing interprofessional collaboration between community pharmacists and general practitioners – A systematic review. Health Soc Care Community. 2019; 27 e189–e212.
| 30569475PubMed |
[36] Liu Y, Doucette WR. Exploring stages of pharmacist-physician collaboration using the model of collaborative working relationship. J Am Pharm Assoc. 2011; 51 412–9a.
| Exploring stages of pharmacist-physician collaboration using the model of collaborative working relationship.Crossref | GoogleScholarGoogle Scholar |
[37] Bryant LJM, Coster G, Gamble GD, McCormick RN. General practitioners’ and pharmacists’ perceptions of the role of community pharmacists in delivering clinical services. Res Social Adm Pharm. 2009; 5 347–62.
| General practitioners’ and pharmacists’ perceptions of the role of community pharmacists in delivering clinical services.Crossref | GoogleScholarGoogle Scholar |
[38] Jorgenson D, Laubscher T, Lyons B, Palmer R. Integrating pharmacists into primary care teams: barriers and facilitators. Int J Pharm Pract. 2014; 22 292–9.
| Integrating pharmacists into primary care teams: barriers and facilitators.Crossref | GoogleScholarGoogle Scholar | 24279947PubMed |
[39] Bradley F, Ashcroft D, Noyce P. Integration and differentiation: a conceptual model of general practitioner and community pharmacist collaboration. Res Social Adm Pharm. 2012; 8 36–46.
| Integration and differentiation: a conceptual model of general practitioner and community pharmacist collaboration.Crossref | GoogleScholarGoogle Scholar | 21454138PubMed |
[40] Xyrichis A, Lowton K. What fosters or prevents interprofessional teamworking in primary and community care? A literature review. Int J Nurs Stud. 2008; 45 140–53.
| What fosters or prevents interprofessional teamworking in primary and community care? A literature review.Crossref | GoogleScholarGoogle Scholar | 17383655PubMed |
[41] Chaar BB, Wang H, Day CA, et al. Factors influencing pharmacy services in opioid substitution treatment. Drug Alcohol Rev. 2013; 32 426–34.
| Factors influencing pharmacy services in opioid substitution treatment.Crossref | GoogleScholarGoogle Scholar | 23442133PubMed |
[42] Rosenthal M. Qualitative research methods: why, when, and how to conduct interviews and focus groups in pharmacy research. Curr Pharm Teach Learn. 2016; 8 509–16.
| Qualitative research methods: why, when, and how to conduct interviews and focus groups in pharmacy research.Crossref | GoogleScholarGoogle Scholar |
[43] Smith EM. Telephone interviewing in healthcare research: a summary of the evidence. Nurse Res. 2005; 12 32–41.
| Telephone interviewing in healthcare research: a summary of the evidence.Crossref | GoogleScholarGoogle Scholar | 15793975PubMed |
[44] Deering DE, Sheridan J, Sellman JD, et al. Consumer and treatment provider perspectives on reducing barriers to opioid substitution treatment and improving treatment attractiveness. Addict Behav. 2011; 36 636–42.
| Consumer and treatment provider perspectives on reducing barriers to opioid substitution treatment and improving treatment attractiveness.Crossref | GoogleScholarGoogle Scholar | 21276664PubMed |
[45] Deering D, Horn J, Frampton CM. Clients’ perceptions of opioid substitution treatment: an input to improving the quality of treatment. Int J Ment Health Nurs. 2012; 21 330–9.
| Clients’ perceptions of opioid substitution treatment: an input to improving the quality of treatment.Crossref | GoogleScholarGoogle Scholar | 22564199PubMed |
[46] Lea T, Sheridan J, Winstock AR. Consumer satisfaction with opioid treatment services at community pharmacies in Australia. Pharm World Sci. 2008; 30 940–6.
| Consumer satisfaction with opioid treatment services at community pharmacies in Australia.Crossref | GoogleScholarGoogle Scholar | 18850299PubMed |
[47] Le P-P, Braunack-Mayer A. Perspectives on privacy in the pharmacy: the views of opioid substitution treatment clients. Res Social Adm Pharm. 2019; 15 1021–6.
| Perspectives on privacy in the pharmacy: the views of opioid substitution treatment clients.Crossref | GoogleScholarGoogle Scholar | 30777646PubMed |
