Hohmann Lindsey, Diggs Kavon, Valle-Ramos Giovanna, Richardson Jessica, Phillippe Haley, Correia Chris, Marlowe Karen, Fox Brent I
Auburn University Harrison College of Pharmacy, Department of Pharmacy Practice, 1330 Walker Building, Auburn, AL 36849, USA.
Auburn University College of Liberal Arts, Department of Psychological Sciences, 221 Cary Hall, Auburn, AL 36849, USA.
Explor Res Clin Soc Pharm. 2024 Sep 5;16:100503. doi: 10.1016/j.rcsop.2024.100503. eCollection 2024 Dec.
Rural US regions experience lower naloxone dispensing rates compared to urban counterparts, particularly in Alabama. In light of this, strategies to enhance opioid counseling and naloxone services (OCN) in rural community pharmacies are critical. However, organizational readiness to implement OCN in rural versus urban contexts where resource networks may differ is not well understood.
The purpose of this study was to explore organizational readiness and identify factors associated with implementation of OCN in rural versus urban Alabama community pharmacies.
Alabama community pharmacists and technicians were recruited to participate in an anonymous online cross-sectional survey via email. The survey instrument was adapted from the Organizational Readiness to Change Assessment (ORCA). Primary outcome measures included 3 overarching ORCA domains (Evidence, Context, and Facilitation) with 19 subscales regarding OCN implementation readiness, measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, pharmacy OCN implementation status (implementer, non-implementer, or in-development) was measured via multiple-choice (1-item). Differences in mean domain and subscale scores between rural and urban pharmacies were evaluated using Mann-Whitney tests and influential factors affecting OCN implementation status were assessed via logistic regression (alpha = 0.05).
Of 171 respondents, the majority were pharmacists (78.6 %) in urban locations (57.1 %). Mean[SD] clinical experience evidence (Evidence) (3.98[0.69] vs 3.74[0.71]; = 0.029), staff culture (Context) (4.04[0.66] vs 3.85[0.76]; = 0.047), service measurement goals (Context) (3.92[0.77] vs 3.66[0.79]; = 0.034), and senior management characteristics (Facilitation) (3.87[0.72] vs 3.71[0.66]; = 0.045) subscales were higher in urban versus rural pharmacies. Notably, 66.7 % of pharmacies were current OCN implementers, and pharmacies with higher ORCA context domain scores had 3.230 greater odds of implementing or being in the process of developing OCN (95 % CI = 1.116-9.350; = 0.031).
Organizational readiness to implement OCN was higher among urban versus rural pharmacies in terms of perceived strength of clinical evidence, staff culture, service measurement goals, and senior management characteristics. Future research may leverage key contextual factors to enhance OCN implementation.
与美国城市地区相比，农村地区的纳洛酮配药率较低，在阿拉巴马州尤为明显。鉴于此，加强农村社区药房阿片类药物咨询和纳洛酮服务（OCN）的策略至关重要。然而，在资源网络可能不同的农村和城市环境中，实施OCN的组织准备情况尚不清楚。
本研究旨在探讨阿拉巴马州农村和城市社区药房实施OCN的组织准备情况，并确定与之相关的因素。
通过电子邮件招募阿拉巴马州的社区药剂师和技术人员参与一项匿名在线横断面调查。调查工具改编自组织变革准备评估（ORCA）。主要结局指标包括ORCA的3个总体领域（证据、背景和促进），涉及19个关于OCN实施准备情况的子量表，通过5点李克特量表进行测量（1 = 强烈不同意，5 = 强烈同意）。其次，通过多项选择题（1项）测量药房OCN的实施状态（实施者、非实施者或正在开发中）。使用曼-惠特尼检验评估农村和城市药房在平均领域和子量表得分上的差异，并通过逻辑回归评估影响OCN实施状态的影响因素（α = 0.05）。
在171名受访者中，大多数是城市地区的药剂师（78.6%）（57.1%）。城市药房在临床经验证据（证据）（3.98[0.69]对3.74[0.71]；P = 0.029）、员工文化（背景）（4.04[0.66]对3.85[0.
