East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, Tennessee.
Wingate University School of Pharmacy, Wingate, North Carolina.
Am J Pharm Educ. 2019 Jun;83(5):6767. doi: 10.5688/ajpe6767.
To examine the extent to which theory of planned behavior (TPB) constructs and demographic characteristics explain pharmacy students' dispensing intentions in ethically or legally gray areas involving potential substance misuse or abuse. Two cohorts of third-year Doctor of Pharmacy (PharmD) students (n=159) were provided with five written cases describing common "gray area" dispensing scenarios in community practice involving medications and devices with potential for misuse or abuse (eg, long-term buprenorphine maintenance prescription without evidence of tapering, early refill of a narcotic for an out-of-town patient, non-prescription sale of pseudoephedrine). Students completed a 12-item survey instrument for each case. Items assessed whether the student would dispense the medication or device in the given scenario, how many times in 10 similar scenarios the student would dispense the medication or device, attitudes regarding dispensing, and subjective norm and perceived behavioral control beliefs. Wide variation in the percentages of students who would dispense the medications or devices was noted across the five scenarios (14% in the buprenorphine scenario to 61% in the pseudoephedrine scenario). Attitude scores significantly predicted dispensing decisions in all scenarios (<.001), whereas subjective norm and perceived behavioral control beliefs were significant predictors of dispensing only in select case scenarios. Gender and community pharmacy work experience did not consistently predict dispensing intentions. Student attitudes consistently predicted intent to dispense across five gray practice scenarios. These findings can be used to inform development of educational interventions that influence students' attitudes and self-awareness in community practice decision-making scenarios involving potential substance misuse or abuse.
为了考察计划行为理论（TPB）结构和人口统计学特征在多大程度上可以解释药学专业学生在涉及潜在药物滥用或误用的道德或法律灰色区域内的配药意愿。对两个三年级药学博士（PharmD）学生队列（n=159）进行了研究，他们提供了五个书面案例，描述了社区实践中常见的“灰色区域”配药情况，涉及可能被滥用或误用的药物和器械（例如，长期丁丙诺啡维持处方，没有逐渐减少的证据，提前为外地患者补充麻醉剂，非处方销售伪麻黄碱）。学生为每个案例完成了 12 项调查工具。评估学生是否会在给定情况下配药，学生在 10 个类似情况下会配药的次数，对配药的态度，以及主观规范和感知行为控制信念。在五个案例中，学生配药的比例差异很大（丁丙诺啡案例中为 14%，伪麻黄碱案例中为 61%）。在所有案例中（<.001），态度得分显著预测了配药决策，而主观规范和感知行为控制信念仅在某些案例中是配药的重要预测因素。性别和社区药房工作经验并不能始终预测配药意愿。学生的态度始终预测了在五个灰色实践案例中配药的意图。这些发现可用于告知教育干预措施的开发，这些措施可以影响学生在涉及潜在药物滥用或误用的社区实践决策场景中的态度和自我意识。
