title: Prescription drug abuse communication: A qualitative analysis of prescriber and pharmacist perceptions and behaviors.
abstract: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited.
  
  
  
  This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists.
  
  
  
  Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes.
  
  
  
  Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists.
  
  
  
  Despite the perceived importance of engaging in PDA communication, HCPs reported that prescription drug abuse communication is uncomfortable, variable, multifactorial, and often avoided. The themes that emerged from this analysis support the utility of communication science and health behavior theories to better understand and improve PDA communication behaviors of both prescribers and pharmacists, and thereby improve engagement in PDA prevention and treatment.
authors.affiliation: Department of Pharmacy Practice, East Tennessee State University Gatton College of Pharmacy, P.O. Box 70657, Johnson City, TN 37614, USA. Electronic address: hagemeier@etsu.edu.
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Hagemeier
authors.affiliation: Department of Family Medicine, East Tennessee State University Quillen College of Medicine, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Tudiver
authors.affiliation: East Tennessee State University Gatton College of Pharmacy, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Brewster
authors.affiliation: East Tennessee State University Gatton College of Pharmacy, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Hagy
authors.affiliation: East Tennessee State University College of Public Health, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Hagaman
authors.affiliation: Department of Community and Behavioral Health, East Tennessee State University College of Public Health, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Pack
mesh_terms: D000328:Adult; D001061:Appalachian Region; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003157:Community Pharmacy Services / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006282:Health Personnel / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010465:Perception; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D010820:Physicians / Q000458:organization & administration* / Q000592:standards; D063487:Prescription Drug Misuse / Q000517:prevention & control*; D011320:Primary Health Care / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration; D012649:Self Concept
keywords: Communication; Pharmacist; Prescriber; Prescription drug abuse; Qualitative