Prescriber and Dispenser Prescription Drug Abuse Communication andPrescribing/Dispensing Behaviors: A Qualitative Analysis

Abstract

Context: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and dispenser health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research is lacking on HCP PDA communicative behavioral engagement and factors that influence it. Objective: To describe PDA-related communicative behaviors and perceptions of primary care prescribers and community pharmacists. Design: Qualitative, semi-structured interprofessional and profession-specific focus groups were conducted, transcribed, coded, and thematically analyzed by two researchers. Established communication domains (communication apprehension, self-perceived communication competence, and willingness to communicate) guided focus group interviews. Setting: Appalachian Research Network (AppNET) PBRN clinics and communities. Participants: AppNET primary care prescribers (N=19) and community pharmacists (N=16). Main and Secondary Outcome Measures: Inductively derived themes resulting from focus groups. Results: Twelve themes were noted across two communication domains: HCP-patient communication (N=6) and HCP-HCP communication (N=6). HCP-patient communication engagement was influenced by multiple patient factors, with objective data (e.g., urine drug screens, distance travelled to practice) weighed heavily. Multiple practice barriers to communication were noted, including time pressures and a lack of screening resources. Difficult or uncomfortable conversations were often avoided by HCPs and substituted with simplified prescribing/dispensing conversations or policies. Dispenser to prescriber and prescriber to dispenser communication was described as rare and often perceived to be ineffective. Counter-intuitively, prescriber to dispenser communication was reported to have decreased after implementation of state prescription drug monitoring programs. Dispensers reported not being perceived as colleagues or teammates to prescribers in prescription drug abuse prevention and treatment. Prescribing behaviors were often questioned by dispensers, and some prescribers questioned dispensing behaviors. Conclusions: HCP prescription drug abuse communication is situational and influenced by patient, practice, and HCP characteristics. Identified themes will inform development of PDA-specific communication assessments that can be used to target and evaluate PDA communication interventions