Senior nurses' perspectives on the transfer of opioid substitution treatment clients from clinics to community pharmacy

Abstract

Introduction and Aims: There is unmet demand for opioid substitution treatment (OST) in New South Wales, Australia, with many public clinics reporting long waitlists. Recently, some community pharmacies have reported a lack of referrals from public clinics. To obtain insight into this apparent contradiction, this study explored the perspectives of senior nurses in public OST clinics regarding client transfers to community pharmacies. Design and Methods: Semi-structured interviews were conducted with nine senior nurses from eight (20%) public OST clinics in New South Wales regarding: the nurses' experience in OST provision, factors affecting client transfer, opinions on pharmacy OST services and relationships with community pharmacies. Interviews were audio-recorded and transcribed verbatim. NVivo was used for initial analysis and coding of the transcripts. Emerging themes were repeatedly analysed and refined by consensus discussion. Results: Most clinics reported being at or over capacity. Nurse identified barriers to transfer included: difficulty motivating reluctant clients, clients' unwillingness to pay for pharmacy supervised dispensing, lack of convenient pharmacy providers and unstable clients. Despite overall good collaborations with community pharmacies, some aspects could be improved, especially face-to-face visits and education around clinic procedures. Discussion and Conclusion: This study highlights the complex barriers encountered by senior nurses in the transfer of OST clients from clinics to community pharmacies. Improved collaboration with pharmacies and subsidised or standardised dispensing fees may enhance the transfer of clients to pharmacies and improve clinics throughput.