Patwardhan Pallavi D, Chewning Betty A
Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, Wisconsin 53705, USA.
Int J Pharm Pract. 2009 Aug;17(4):221-9. doi: 10.1211/ijpp/17.04.0005.
A preliminary qualitative study was conducted to identify key facilitators and barriers for pharmacists' adoption of a brief tobacco-cessation protocol, Ask-Advise-Refer (AAR).
Ten community pharmacists were interviewed using semi-structured, face-to-face interviews with open-ended questions. Purposive and saturation sampling techniques were applied to identify participants and determine sample size respectively. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers independently coded all transcripts to identify prominent themes. Appropriate measures were taken to ensure study rigor and validity.
All facilitators and barriers identified were grouped into nine distinct themes. Pharmacists' fear of negative patient reaction was the most prominent barrier to initiating tobacco-cessation discussions with patients. Other themes identified in decreasing order of prevalence were pharmacists perceiving a rationale for initiating tobacco cessation, pharmacy environment, pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit, patient initiation of tobacco-cessation or worsening-health discussion, pharmacists' perceptions of AAR characteristics, length of pharmacist-patient relationship/rapport with patients, low expectations of pharmacy patrons and pharmacists' communication ability.
This study highlights the potential fear among pharmacists about negative reactions from patients in response to initiating tobacco cessation discussions. Based on the results of this study it is hypothesized that the following strategies would facilitate adoption of AAR: (1) train pharmacists to initiate cessation discussions; (2) initially target discussions with patients who have a disease or medication adversely affected by tobacco use; (3) encourage patient enquiry about pharmacy cessation services through visual cues; and (4) help pharmacists set up a workflow system compatible with the AAR protocol.
开展一项初步定性研究，以确定药剂师采用简短戒烟方案“询问-建议-转介”（AAR）的关键促进因素和障碍。
采用半结构化面对面访谈，对10名社区药剂师提出开放式问题进行访谈。分别运用立意抽样和饱和抽样技术确定参与者和样本量。访谈进行录音并转录。采用主题分析法，两名评审员独立对所有转录本进行编码，以确定突出主题。采取适当措施确保研究的严谨性和有效性。
所确定的所有促进因素和障碍被归纳为9个不同主题。药剂师对患者负面反应的恐惧是与患者开展戒烟讨论的最突出障碍。按出现频率递减顺序确定的其他主题包括：药剂师认为有开展戒烟工作的理由、药房环境、药剂师对患者讨论戒烟/戒烟意愿的认知/先验知识、患者主动提出戒烟或健康状况恶化讨论、药剂师对AAR特点的认知、药剂师与患者关系/融洽程度的长短、对药房顾客的低期望以及药剂师的沟通能力。
本研究突出了药剂师对开展戒烟讨论时患者负面反应的潜在担忧。基于本研究结果，假设以下策略将促进AAR的采用：（1）培训药剂师开展戒烟讨论；（2）最初针对那些患有受烟草使用负面影响的疾病或正在服用受烟草使用负面影响药物的患者进行讨论；（3）通过视觉提示鼓励患者询问药房戒烟服务；（4）帮助药剂师建立与AAR方案兼容的工作流程系统。
