South Australian rural community pharmacists and the provision of methadone, buprenorphine and injecting equipment

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Abstract

Objective

To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia.

Setting

Rural South Australia.

Method

Analysis of data obtained from earlier focus-group interviews enabled compilation of key issues for the development of a semi-structured questionnaire. Fifty-one potential participants were contacted. Twenty-five rural South Australian community pharmacists were interviewed through a 15-20-min semi-structured telephone questionnaire. Interview responses were manually recorded. Thematic analysis of the transcribed data by one researcher enabled determination of key issues.

Key findings

Fifty-one potential pharmacies were contacted and 25 pharmacists were interviewed. All 25 pharmacists had experience in the provision of OST services, 22 sold sterile injecting equipment and 10 offered needle exchange. Exploration of service issues in the context of rural pharmacy practice found that the geographical closeness of a small community may improve rapport with local prescribers, as indicated by 15 of 25 pharmacists. Access to other allied health services was described by 13 of the 25 as difficult. Servicing OST clients can have a negative impact on pharmacy business, is not profitable for rural pharmacies and only seven of the 25 felt adequately remunerated for the provision of their services. Client debt was an identified issue and the practice of withholding doses because of lack of payment was supported by 10 participants and not supported by an equal number. Mentored practice was highlighted as a potential area for future training, as was managing clients' debts. In addition, pharmacy structural changes to provide a private dosing area would preserve confidentiality during supervised dosing.

Conclusion

Access to allied health services in regional areas could be better coordinated. Financial incentives for South Australian pharmacies, without increasing the cost of treatment for clients, requires further exploration.

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