title: Developing a framework of care for opioid medication misuse in community pharmacy.
abstract: BACKGROUND
  Prescription opioid misuse is a major public health concern in the US. Few resources exist to support community pharmacists engaging patients who misuse or are at risk for misuse.
  
  
  OBJECTIVE
  This report describes the results of the execution of the ADAPT-ITT model (a model for modifying evidence-based behavioral interventions to new populations and service settings) to guide the development of a behavioral health framework for opioid medication misuse in the community pharmacy setting.
  
  
  METHODS
  Pharmacy, addiction, intervention, and treatment experts were convened to attend a one-day meeting to review the empirical knowledgebase and discuss adapting the screening, brief intervention, and referral to treatment (SBIRT) protocol for addressing opioid medication misuse in community pharmacy. Qualitative data gathered from the meeting were analyzed by 2 independent coders in a 2-cycle process using objective coding schemes. Percentage of agreement and Cohen's Kappa were calculated to assess coder agreement.
  
  
  RESULTS
  First-cycle coding identified 4 distinct themes, with coder percentage of agreement ranging from 93.5 to 99.6% and with Kappa values between 0.81 and 0.93. Second-cycle coding identified 10 sub-themes, with coder percentage of agreement ranging from 83 to 99.8% and with Kappa values between 0.58 and 0.93. Identified themes and sub-themes encompassed patient identification, intervention, prevention, and referral to treatment.
  
  
  CONCLUSIONS
  Focus of screening efforts in the emerging model should capitalize on pharmacists' knowledge of medication management. Screening likewise should be multidimensional in order to facilitate patient-centered interventions that activate additional disciplines able to interface with patients at risk or involved in medication misuse.
authors.affiliation: University of Pittsburgh School of Social Work, 4200 Fifth Ave., Pittsburgh, PA 15260, USA; University of Pittsburgh, Department of Psychiatry, 3811, Pittsburgh, PA 15213, USA. Electronic address: gcochran@pitt.edu.
authors.forename: Gerald
authors.initials: G
authors.lastname: Cochran
authors.affiliation: University of Pittsburgh School of Medicine, Department of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA; VA Pittsburgh Healthcare System, University Drive C (151-C), Pittsburgh, PA 15240-1001, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: University of Texas El Paso, Department of Psychology, El Paso, TX 79968, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Field
authors.affiliation: University of Pittsburgh School of Pharmacy, 501 Terrace St, Pittsburgh, PA 15213, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bacci
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
authors.forename: Ranjita
authors.initials: R
authors.lastname: Dhital
authors.affiliation: University of Pittsburgh School of Social Work, 4200 Fifth Ave., Pittsburgh, PA 15260, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ylioja
authors.affiliation: Johns Hopkins Medicine, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA.
authors.forename: Maxine
authors.initials: M
authors.lastname: Stitzer
authors.affiliation: University of Pittsburgh, Department of Psychiatry, 3811, Pittsburgh, PA 15213, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kelly
authors.affiliation: University of Pittsburgh School of Pharmacy, 501 Terrace St, Pittsburgh, PA 15213, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Tarter
mesh_terms: D000701:Analgesics, Opioid; D003157:Community Pharmacy Services / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000458:organization & administration; D010595:Pharmacists; D024382:Professional Role; D019966:Substance-Related Disorders / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid
keywords: Adherence; Medication management; Opioid misuse; Qualitative research