Patient reported goals for medications for opioid use disorder: A theory of proximal goal attainment.

Background: There exist substantial patient barriers to accessing medications for opioid use disorder (MOUD), including travel distance, stigma, and availability of MOUD providers. Yet, despite these barriers, there exists a subset of patients who possess the requisite motivation to seek and remain adherent to treatment. Objective: To explore patient-derived goals in MOUD treatment-adherent patients. Methods: This study used in-depth interviews with patients receiving methadone who were enrolled in opioid treatment programs (OTPs) across Tennessee. Participants were recruited from 12 different OTPs to participate in telephonic semi-structured interviews to a point of saturation. Participants had to be adherent to treatment, in treatment for 6 months or greater, and English speaking. Analysis occurred inductively using a constructivist approach to Grounded Theory. Results: In total, 17 patient interviews were conducted in the spring of 2021. Participants described goal setting across three general stages of treatment: (1) addressing acute physical and emotional needs upon treatment entry, (2) development of supportive structure and routine to develop healthy skills facilitated by treatment team, and (3) identifying and pursuing future-focused goals not directly linked to treatment. A Proximal Goals in MOUD Framework is introduced. Conclusion: In this qualitative study on patient reported goals in MOUD it was found that goals are transitory and relative to the stage of treatment. Further research is needed to better understand goal evolution over the course of treatment and its impact on treatment retention.

Pharmacy personnel comfort and confidence in screening for social needs: A pilot study.

BACKGROUND: Addressing social needs (such as lack of adequate housing, food, and transportation) has been shown to improve medication adherence and overall patient outcomes. However, screening for social needs during routine patient care can be challenging due to lack of knowledge of social resources and adequate training. OBJECTIVES: The primary objective of this study is to explore the comfort and confidence of community pharmacy personnel in a chain community pharmacy when discussing social determinants of health (SDOH) with patients. A secondary objective of this study was to assess the impact of a targeted continuing pharmacy education program in this area. METHODS: Baseline confidence and comfort were measured through a brief online survey consisting of Likert scale questions regarding various aspects of SDOH (e.g., importance and benefit, knowledge of social resources, relevant training, workflow feasibility). Subgroup analysis of respondent characteristics was conducted to examine differences between respondent demographics. A targeted training was piloted, and an optional posttraining survey was administered. RESULTS: The baseline survey was completed by 157 pharmacists (n = 141, 90%) and pharmacy technicians (n = 16, 10%). Overall, the pharmacy personnel surveyed lacked confidence and comfort when conducting screenings for social needs. There was not a statistically significant difference in comfort or confidence between roles; however, subgroup analysis revealed trends and significant differences between respondent demographics. The largest gaps identified were lack of knowledge of social resources, inadequate training, and workflow concerns. Respondents of the posttraining survey (n = 38, response rate = 51%) reported significantly higher comfort and confidence than the baseline. CONCLUSION: Practicing community pharmacy personnel lack confidence and comfort in screening patients for social needs at baseline. More research is needed to determine if pharmacists or technicians may be better equipped to implement social needs screenings in community pharmacy practice. Common barriers may be alleviated with targeted training programs to address these concerns.

Community-Centered Patient Journey Map in Opioid Use Disorder: A Tool to Address Compassion Fatigue among Community Pharmacists.

Community pharmacists have become increasingly exposed to opioid use disorders in recent decades. However, both pharmacist training and traditional practice environments have not been adequate to prepare the pharmacist for both the patient care needs and regulatory barriers of patients experiencing opioid use disorders (OUD). As a result, there is a need to increase pharmacists' awareness of both the overall patient experience as they navigate their OUD and the role of the community pharmacy as a touchpoint within that experience. To this end, a Community-Centered Patient Journey in Drug Addiction Treatment journey map was developed with expert insights, clinical experience, and in-depth interviews (conducted in spring of 2021) with 16 participants enrolled in licensed opioid treatment programs in Tennessee. Patients, policymakers, clinicians, and academic researchers were involved in the map development. Lived experiences of key informants were captured via in-depth interviews. A consensus decision-making approach was used throughout the patient journey map development process. The final patient journey map illustrates a non-linear pathway, describes the central role of the patient's community, and emphasizes three major "pain points" within the system (access, adherence, and affordability). Future research should investigate the impact of such a journey map on pharmacy personnel's knowledge, attitudes, and behaviors.

Patient perspectives of discussing social determinants of health with community pharmacists.

BACKGROUND: Social determinants of health (SDOH) have a considerable impact on the lives and health outcomes of Black communities. Although the implementation of social needs screening in various clinical settings has been studied, the patient perspective of discussing SDOH with health care providers has not been thoroughly investigated. There is an opportunity for community pharmacists to help identify social risk factors and address social needs, particularly in minoritized communities. OBJECTIVES: The objectives of this project were to (1) characterize the perspectives of Black patients regarding social risk discussions with community pharmacists and (2) to develop a framework for community pharmacists to engage in conversations with patients about social risk factors. METHODS: A qualitative study was conducted using principles of grounded theory. Patient perspectives regarding discussions of 5 key determinants of health (economic stability, education, social and community context, health and health care, and neighborhood and built environment) were elicited through semistructured interviews. Data analysis included interpretation of interview transcripts from 14 Black adults living in medically underserved areas in Memphis, TN. Charmaz's approach to theory development was followed. RESULTS: Three themes emerged to characterize the needs and expectations for patients in discussing social risk factors with community pharmacists. The themes of rationale, relationship, and resources were compiled to construct the newly developed Social Determinants of Health Patient Communication Framework. This framework describes the key factors that affected the patient receptiveness and willingness to discuss their social needs. CONCLUSION: Although patients are open to sharing social issues with community pharmacists, they may be reluctant to discuss social factors if initial understanding, personal connection, or resources are not present. This proposed, novel framework is a step toward improving the assessment of SDOH for underserved Black patients within community pharmacies. This framework can also be used for future education of pharmacists and other health care providers.