J Am Pharm Assoc (2003). 2021 Nov-Dec;61(6):753-760.e1. doi: 10.1016/j.japh.2021.06.004. Epub 2021 Jun 11.
In 2016, the Virginia Health Commissioner signed a standing order into law allowing licensed pharmacists to dispense opioid receptor antagonists (ORAs) for overdose reversal.
Using the theory of planned behavior as an initial guide to study development, the aim of this qualitative study was to explore community pharmacists' attitudes, subjective norm, perceived behavioral control, and behavioral intention toward dispensing ORAs under a standing order in Virginia.
Semi-structured interviews were conducted with community pharmacists across the Commonwealth between June 2018 and October 2019. Interviews were recorded, transcribed verbatim, and thematically analyzed.
Twenty-one community pharmacists were interviewed. Pharmacists were confused about the specifics and the processes involved with dispensing naloxone under the standing order. Furthermore, many recognized the underuse of the standing order. Positive attitudes focused on the life-saving action of ORAs. Negative attitudes included encouraging risky behaviors by patients, negatively affecting the patient-pharmacist relationship, offending or contributing to stigmatizing patrons, and having liability issues to the pharmacy. Subjective norms regarding dispensing of ORAs under the standing order were perceived to be favorable among peer pharmacists and primary care and emergency department physicians but may be seen as profit-seeking by patients. Barriers to service provision included lack of guidance from corporate offices (in chain pharmacies), inadequate training, patient out-of-pocket costs, reimbursement issues, inadequate staffing and time, and stigma. Facilitators comprised the existence of practice site-specific protocols, the REVIVE! training, technician support, increased community awareness, physician collaboration, pharmacist training, and employer guidance. Whereas some pharmacists intended to become more familiarized with the standing order, others did not intend to actively identify patients who were at risk of an opioid overdose.
Pharmacists expressed mixed behavioral intention toward dispensing ORAs under the standing order. Future research should focus on quantifying the uptake of the standing order at the state level.
2016 年，弗吉尼亚州卫生专员签署了一项法定命令，允许持照药剂师分发阿片类药物受体拮抗剂（ORAs）以逆转药物过量。
本项定性研究以计划行为理论为初步指导，旨在探讨弗吉尼亚州社区药剂师在法定命令下分发 ORA 的态度、主观规范、感知行为控制和行为意向。
2018 年 6 月至 2019 年 10 月，在整个弗吉尼亚州，对社区药剂师进行了半结构化访谈。对访谈进行了录音、逐字记录，并进行了主题分析。
共采访了 21 名社区药剂师。药剂师对根据法定命令分发纳洛酮的具体细节和程序感到困惑。此外，许多人认识到该法定命令的使用率较低。积极的态度集中在 ORA 的救生作用上。负面态度包括鼓励患者冒险行为、对医患关系产生负面影响、冒犯或助长患者的污名化、以及给药房带来法律责任问题。关于根据法定命令分发 ORA 的主观规范，在同行药剂师、初级保健医生和急诊医生中被认为是有利的，但在患者中可能被视为逐利行为。服务提供的障碍包括连锁药店的企业办公室缺乏指导、培训不足、患者自费、报销问题、人员和时间不足以及污名化。促进因素包括特定实践场所协议的存在、REVIVE！培训、技术人员支持、社区意识的提高、医生合作、药剂师培训和雇主指导。尽管一些药剂师打算更熟悉该法定命令，但另一些药剂师并不打算主动识别有阿片类药物过量风险的患者。
药剂师对根据法定命令分发 ORA 的行为意向存在分歧。未来的研究应侧重于在州一级量化该法定命令的采用情况。
