Patient counselling on opioids by pharmacy technicians: A mixed-method study to explore facilitators and barriers

Objectives: This study investigates community pharmacy technicians' (PTs) counselling practices for patients prescribed opioids and identifies facilitators and barriers influencing their counselling behaviour. Methods: A sequential exploratory mixed-method study involving interviews and a questionnaire was conducted among PTs, working in Dutch community pharmacies. PTs were recruited via professional networks, panels and social media. Inductive thematic analysis was performed for interviews. Descriptive statistics of questionnaires was performed and associations between behaviour of discussing dependency and background characteristics (1), barriers (2) and beliefs (3) were tested. Results: Nineteen topics emerged from 18 interviews. Out of 252 questionnaire-respondents, most PTs consistently discussed dosage and common side effects during the first opioid dispense. Although 92 % considered discussing opioid dependency important, only 62 % frequently performed it. Barriers included a lack of information about the indication (p = 0.012), lack of work agreements (p = 0.017), time (p = 0.022), feeling insecure (p = 0.041), less work experience (p = 0.025) and the belief that prescribers are responsible for discussing opioid dependency with patients (p = 0.018). Conclusion: The high importance that PTs place on counselling patients on opioid dependency does not match their behaviour. To close this gap and optimize the role of PTs in promoting safe opioid use, organizational and competency-related barriers must be addressed. This includes clear work protocols, communication training and including the indication on opioid prescriptions. Innovation: This research focuses on an underexplored group involved in patients' opioid management, crucial for designing effective interventions, as PTs frequently have direct patient contact.