Gateway Centre of Excellence in Rural Health, Seaforth, Ontario, Canada.
School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
J Rural Health. 2018 Dec;34(1):23-30. doi: 10.1111/jrh.12264. Epub 2017 Sep 5.
Misuse of opioids has become a public health concern across North America. Rural patients have limited access to methadone maintenance treatment (MMT), an opioid addiction-treatment service that could be offered by community pharmacists. The aim of this study was to identify rural community pharmacists' perceived barriers, motivations, and solutions to offering MMT to their patients.
One-on-one, semistructured interviews were conducted with 11 community pharmacists who practice in rural southwestern Ontario. Interview transcripts were analyzed using inductive qualitative content analysis.
Increased workload, extended operating hours, and concerns about safety, theft, burglary, community resistance, and availability of methadone training courses were identified as pharmacist-related barriers to providing MMT services. Professional satisfaction and community service were primary motivations for offering the service. Limited pharmacy staff availability exacerbated concerns about increased workload and security. Slower rural emergency-response times were cited among safety concerns. Participating pharmacists felt that rural regions had fewer MMT prescribers and that rural community members had greater apprehension about addiction-treatment services than those in urban communities. Pharmacists proposed that coordinating MMT service provision across multiple community pharmacies in the region could help improve access to treatment among their patients.
Rural community pharmacy practice has unique barriers to implementing and providing MMT services. A coordinated, multipharmacy approach may be an option to provide and expand MMT services in rural regions.
阿片类药物滥用已成为北美各地的一个公共卫生关注点。农村地区的患者获得美沙酮维持治疗（MMT）的机会有限，而 MMT 是一种可以由社区药剂师提供的阿片类药物成瘾治疗服务。本研究旨在确定农村社区药剂师提供 MMT 服务的感知障碍、动机和解决方案。
对在安大略省西南部农村地区执业的 11 名社区药剂师进行了一对一的半结构化访谈。使用归纳定性内容分析法对访谈记录进行了分析。
增加工作量、延长营业时间、对安全、盗窃、入室盗窃、社区抵制以及美沙酮培训课程可用性的担忧被确定为提供 MMT 服务的药剂师相关障碍。提供服务的主要动机是专业满意度和社区服务。有限的药房工作人员可用性加剧了对增加工作量和安全性的担忧。在安全问题中提到了较慢的农村紧急响应时间。参与的药剂师认为农村地区的 MMT 处方医生较少，而且农村社区成员对成瘾治疗服务的担忧比城市社区成员更强烈。药剂师提议，在该地区的多个社区药房协调 MMT 服务提供，可以帮助改善患者的治疗机会。
农村社区药房实践在实施和提供 MMT 服务方面存在独特的障碍。协调的多药房方法可能是在农村地区提供和扩大 MMT 服务的一种选择。
