title: Managing inappropriate use of non-prescription combination analgesics containing codeine: A modified Delphi study.
abstract: Misuse and/or dependence upon non-prescription combination analgesics containing codeine (NP-CACC) can result in serious physiological and psychological harms.
  
  
  
  To explore pharmacists' and other health care professionals' ideas and views on strategies for managing NP-CACC misuse and/or dependence in a community pharmacy setting.
  
  
  
  A 3-iteration modified Delphi study was conducted to gain the consensus view of panelists. Forty experts within the fields of pharmacy and drug misuse and/or dependence agreed to be on the panel. Questionnaires explored opinions on issues and possible strategies that could be used to manage NP-CACC misuse and/or dependence. Responses from the first-round questionnaire were summarized and reported back to panelists through the second-round questionnaire for further reflection and evaluation using a 6-point, Likert-type scale. Strategies included in the third-round questionnaire had agreement by more than 80% of panelists. Panelists provided feedback on effectiveness using a 6-point, Likert-type scale for impact.
  
  
  
  The response rates for the 3 rounds were 65%, 67.5% and 55%, respectively. Panelists provided 54 strategies in round 1. In round 2 there was consensus agreement with 31 of these strategies. In round 3 there was consensus that 21 strategies were expected to be effective (>80% of panelists expected the strategy to be effective, median above Somewhat Effective (4), IQD ≤1). Of these, 8 were expected to have the most impact if implemented into clinical practice (chosen by 5 or more panelists in their Top 5 for impact). The strategies identified as effective and likely to have the most impact on NP-CACC misuse/dependence in a community pharmacy setting were: utilization of a national real-time database to monitor product sales to aid identification of at-risk people (100% effectiveness, rank 1 for impact); development of a referral pathway for management of people whom pharmacists have identified as at-risk (95.2% effectiveness, rank 2 for impact), and training to improve pharmacist communication with people (95% effectiveness, rank 2 for impact).
  
  
  
  The high level of consensus achieved indicates that the strategies generated represent useful approaches which could be utilized to manage NP-CACC misuse and/or dependence within community pharmacy in the future.
authors.affiliation: School of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, La Trobe University, P.O. Box 199, Bendigo, Victoria 3552, Australia.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Gibbins
authors.affiliation: School of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, La Trobe University, P.O. Box 199, Bendigo, Victoria 3552, Australia.
authors.forename: Penelope J
authors.initials: PJ
authors.lastname: Wood
authors.affiliation: School of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, La Trobe University, P.O. Box 199, Bendigo, Victoria 3552, Australia. Electronic address: j.spark@latrobe.edu.au.
authors.forename: M Joy
authors.initials: MJ
authors.lastname: Spark
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001291:Attitude of Health Personnel; D003061:Codeine / Q000008:administration & dosage* / Q000009:adverse effects; D003142:Communication; D003157:Community Pharmacy Services / Q000458:organization & administration; D003697:Delphi Technique; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D010595:Pharmacists / Q000458:organization & administration; D024382:Professional Role; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D004366:Nonprescription Drugs; D003061:Codeine
keywords: Codeine containing analgesic; Community pharmacists; Delphi study; Pharmacy practice