Enhancing the role of UK community pharmacy staff in the prevention of prescription and over-the-counter opioid misuse : developing intervention strategies using establishedbehaviour change models

Abstract

Background: Opioids are associated with half of all registered drug poisoning deaths in the UK, yet the rate at which opioids are prescribed remains high. Furthermore, over-the-counter (OTC) opioids can be obtained from pharmacies without a prescription. Community pharmacists have a role to play in preventing opioid misuse since they are responsible for dispensing opioids to patients. This study was aimed at developing strategies for intervention to help enhance community pharmacists’ roles in the prevention of prescription and OTC opioid misuse. Methods: The research involved three studies- a systematic review and two qualitative research. The systematic review was carried out according to PRISMA guidelines and set out to review literature on the barriers and facilitators of community pharmacists’ involvement in prescription and OTC opioid misuse prevention. The Qualitative studies were carried out by conducting one-to-one interviews with 36 participants (Study 2: 28 community pharmacy staff, Study 3: eight policymakers) via Zoom. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model which is used for identifying factors that influence behaviour, and the Behaviour Change Wheel (BCW) model used in developing strategies for intervention were used in classifying identified themes. For the systematic review, database search in Ovid MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO were carried out and narrative synthesis utilising the COM-B model was used for analysis. Data obtained from the qualitative studies were thematically analysed. Findings: Ten articles were included in the review. Barriers and facilitators identified were classified as capabilities (knowledge and skill), opportunities (such as relationship with prescribers, time) and motivation (pharmacists’ attitude). Themes identified from the pharmacy staff interviews were mapped to the COM-B model to identify 22 iii potential areas for intervention while 13 Behaviour Change Techniques (BCT) to target each of these areas were identified from all three studies using the BCW model. These enabled the development of strategies that could help enhance the potential targets, thus enhancing community pharmacists’ roles in the prevention of opioid misuse. These strategies are education and training, collaboration with GPs, change in OTC opioid regulatory practices, and support from commissioners. Conclusion: This research has identified strategies for intervention that could help to enhance community pharmacists’ roles in the prevention of opioid misuse. This finding has provided a baseline for future research on the development of feasible, effective, and cost-effective interventions following the Medical Research Council (MRC) framework.