Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia.
Frankston Mornington Peninsula Primary Care Partnership, Peninsula Health, Victoria, Australia.
Res Social Adm Pharm. 2023 Mar;19(3):526-534. doi: 10.1016/j.sapharm.2022.09.009. Epub 2022 Sep 20.
Demand for medication assisted treatment for opioid dependence (MATOD) in Australia exceeds capacity, particularly in rural and regional areas. There is increasing recognition that community pharmacists are well-positioned to take on expanded roles in MATOD delivery, however there has been limited Australian research exploring attitudes of pharmacists, prescribers, and patients to collaborative models of care.
OBJECTIVE(S): This study aimed to better understand enablers and barriers to a collaborative model for MATOD, to inform implementation in regions where increases in treatment capacity are urgently needed.
Semi-structured telephone interviews were conducted with pharmacists (n = 11), prescribers (n = 6), and patients (n = 8) recruited from the Frankston-Mornington Peninsula region in Victoria, Australia, where transport and access to services have impacts on health care utilisation. The COM-B model was used to explore perceptions of pharmacists' capability, opportunity, and motivations for delivering collaborative care.
There was strong motivation among healthcare professionals to participate in a collaborative model of care, with the main perceived benefits including improvements in accessibility, convenience, and continuity of care, and leverage of pharmacists' high level of patient engagement. Key barriers identified by both pharmacists and prescribers included a perceived lack of pharmacist skills in some areas (capability) and resources (opportunity) to deliver collaborative care in a community pharmacy setting. Established relationships between all stakeholders (social opportunity) and communication between pharmacists and prescribers were identified as facilitators. Barriers and facilitators aligned with seven key areas: skills, confidence, relationships, patient selection, protocols, communication and resources.
Findings informed the development of a collaborative model that was individualised, protocol based, and supported by training and clear processes.
This study identifies specific barriers and facilitators to a pharmacist-prescriber collaborative model of care for MATOD. The resulting model will be tested in a hybrid implementation-effectiveness trial in the Frankston-Mornington Peninsula region.
澳大利亚对阿片类药物依赖药物辅助治疗（MATOD）的需求超过了供应能力，特别是在农村和地区。人们越来越认识到，社区药剂师非常适合在 MATOD 交付中发挥扩展作用，然而，澳大利亚对药剂师、处方者和患者对协作护理模式的态度的研究有限。
本研究旨在更好地了解 MATOD 协作模式的促成因素和障碍，为在急需增加治疗能力的地区实施提供信息。
从澳大利亚维多利亚州弗兰克斯顿-莫宁顿半岛地区招募了药剂师（n=11）、处方者（n=6）和患者（n=8）进行半结构式电话访谈，该地区的交通和服务获取对医疗保健的使用有影响。使用 COM-B 模型探讨药剂师提供协作护理的能力、机会和动机的看法。
医疗保健专业人员参与协作护理模式的动机很强，主要的预期好处包括改善可及性、便利性和护理连续性，并利用药剂师与患者的高度互动。药剂师和处方者都认为存在一些障碍，包括在某些领域（能力）和资源（机会）方面缺乏药剂师技能，无法在社区药房环境中提供协作护理。所有利益相关者之间建立的关系（社会机会）和药剂师与处方者之间的沟通被认为是促进因素。障碍和促进因素与七个关键领域一致：技能、信心、关系、患者选择、协议、沟通和资源。
研究结果为制定协作模式提供了信息，该模式具有个性化、基于协议，并得到培训和明确流程的支持。
本研究确定了 MATOD 药剂师-处方者协作护理模式的具体障碍和促进因素。该模型将在弗兰克斯顿-莫宁顿半岛地区进行混合实施效果试验进行测试。
