A review and narrative synthesis of community pharmacist-led interventions to tackle medicines for pain that are misused

Abstract

Objectives: To undertake a state-of-the-art review and narrative synthesis of current evidence investigating community pharmacist-led interventions addressing analgesic medication misuse. To achieve the objective, a systematic database search was undertaken during October and November 2020 across Embase, Medline, Web of Science and Scopus. Community pharmacy interventions were mapped to the Behaviour Change Wheel to investigate the pharmacist and patient behaviours addressed by the interventions. Outcomes about process and effects were extracted. A risk of bias assessment was undertaken.

Key findings: Five studies undertaken in the USA and Northern Ireland were included. Brief Motivational Interviewing and Medication Therapy Management and the Opioid and Naloxone Education programme demonstrated positive process outcomes and feasibility in delivery. Intervention functions addressing patient and pharmacist behaviours across the studies included education, training, environmental restructuring and enablement. Restrictions were an additional intervention function targeting patient behaviour incorporated in one study. Pharmacist roles involved the identification of potential misusers/abusers, patient education, long-term management, prevention and referral. Low study numbers, non-experimental designs, high risk of bias, incomplete reporting of interventions and heterogeneous outcome measures limited evidence synthesis.

Summary: There is limited evidence of pharmacy interventions and their well-tested impact on pharmacists and patients. There is clinical and methodological heterogeneity across studies. It is pragmatic to suggest that a systems-thinking approach is adopted to investigate the potential role of community pharmacists and engage all stakeholders in the design of a theory-informed intervention. More high-quality studies including larger population sizes undertaken for longer periods of time that are rigorously reported are needed to improve the evidence base.

Keywords: clinical topics; community pharmacy; drug misuse; patient safety; systematic review.