No description available.

This seminar will focus on the problem of prescription and other opioid abuse in Appalachia. Topics include epidemiology of the problem, a model for understanding the scope and complexity of the problem and key lessons learned in Tennessee. The presentation will conclude with a discussion of current efforts to address the problem by groups in the NE Tennessee and SW Virginia region.

Context: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and dispenser health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research is lacking on HCP PDA communicative behavioral engagement and factors that influence it. Objective: To describe PDA-related communicative behaviors and perceptions of primary care prescribers and community pharmacists. Design: Qualitative, semi-structured interprofessional and profession-specific focus groups were conducted, transcribed, coded, and thematically analyzed by two researchers. Established communication domains (communication apprehension, self-perceived communication competence, and willingness to communicate) guided focus group interviews. Setting: Appalachian Research Network (AppNET) PBRN clinics and communities. Participants: AppNET primary care prescribers (N=19) and community pharmacists (N=16). Main and Secondary Outcome Measures: Inductively derived themes resulting from focus groups. Results: Twelve themes were noted across two communication domains: HCP-patient communication (N=6) and HCP-HCP communication (N=6). HCP-patient communication engagement was influenced by multiple patient factors, with objective data (e.g., urine drug screens, distance travelled to practice) weighed heavily. Multiple practice barriers to communication were noted, including time pressures and a lack of screening resources. Difficult or uncomfortable conversations were often avoided by HCPs and substituted with simplified prescribing/dispensing conversations or policies. Dispenser to prescriber and prescriber to dispenser communication was described as rare and often perceived to be ineffective. Counter-intuitively, prescriber to dispenser communication was reported to have decreased after implementation of state prescription drug monitoring programs. Dispensers reported not being perceived as colleagues or teammates to prescribers in prescription drug abuse prevention and treatment. Prescribing behaviors were often questioned by dispensers, and some prescribers questioned dispensing behaviors. Conclusions: HCP prescription drug abuse communication is situational and influenced by patient, practice, and HCP characteristics. Identified themes will inform development of PDA-specific communication assessments that can be used to target and evaluate PDA communication interventions.

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Abstract available through Pharmacotherapy.

Prescription drug abuse (PDA) is an epidemic nationwide and has disproportionally impacted the Southern Appalachian region. Situated within a geographic area known for pervasive PDA and its consequences, The Gatton College of Pharmacy and Academic Health Sciences Center (AHSC) at East Tennessee State University are proactively engaging the Region and its health professions students to address the problem. Over the College’s six-year history of community engagement in PDA, efforts have focused on primary prevention activities, PDA treatment, awareness, education, and interprofessional collaboration as the key impact sectors. Notable programs include Generation Rx, Operation Rx Disposal, continuing education (CE) programming, and establishment of the ETSU Diversity-promoting Institutions Drug Abuse Research Program. In 2013-2014, 3 faculty and 38 Generation Rx pharmacy students engaged 4000 children and adolescents in PDA prevention education. Operation Rx Disposal employed 5 faculty members and 35 student pharmacists to assist more than 1000 households in removing unwanted medication from their homes through conduction of drug take-back events. Over 2000 health care providers from regional communities participated in PDA CE events conducted by 3 pharmacy faculty members. Additionally, 3 externally funded, PDA-specific grants totaling $2.26 million were awarded to pharmacy faculty members to engage communities, health care professionals, and students in innovative PDA prevention research. The College’s efforts have been nationally recognized by peers, professional organizations, state boards of pharmacy and within the evidentiary literature.

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The strategic prevention framework (SPF) is a data-driven operating system to assist designing evidence-based substance abuse prevention programs. The study performed here was to assess the effectiveness of the SPF as a prevention planning system. One purpose of this study was to determine the implementation fidelity of the programs that used the SPF process; the other purpose was to assess effectiveness of the SPF process. This study utilized a set of data collected by the national cross site evaluation team on all jurisdictions that implemented the SPF. A subset of communities collected and reported at least 2 pre-implementation and at least 2 post implementation outcomes data. The minimum sample size for the study was determined by using Cohen's d criteria. The assessments were performed using both qualitative and quantitative methods by using data collected from multiple levels with a quasi-experimental design. The qualitative data were analyzed using qualitative software with key word searches to examine implementation processes, and the quantitative data were analyzed using descriptive statistics and inferential methods such as Student t tests to examine and compare outcomes. Results show that the communities in the study implemented the SPF process with fidelity and that there were changes in desired directions. Factors related to improvements include sufficient internal resources and monitoring follow-through. This research has important implications for social change since substance abuse is a major social issue that has consequences across life span. Recent studies have shown that many behavioral problems have similar risk factors and that improvements for some behavioral problems will most likely have beneficial effects on other related problems.

The term femicide was used to refer to the murder of women. Intimate femicide referred to the murder of women by men with whom they had an intimate love relationship. The purpose of this research was to make visible the intimate and domestic nature of femicide by describing all femicides in Saskatchewan between 1988 and 1992 inclusive. A second purpose of this research was to learn about prevention both from committed femicides and from two women who had survived an attempted intimate femicide. This research was feminist in nature and utilized elements of both quantitative and qualitative research methodologies. Data were gathered on all women known to be murdered between 1988 and 1992 from sources such as newspaper searches, coroners' reports, and police files. Based on these data, femicides were classified as intimate or non-intimate femicides and as possibly preventable or not preventable within the femicidal incident itself. Further data were gathered from interviews with two women who had survived an attempted intimate femicidal attack. Both sets of data were then reviewed and themes relating to the prevention of femicide were elicited. These themes focussed on failures of the communities in which these women resided or were murdered, failures of the medical community to correctly identify femicidal men, failures of the judicial system in their dealings with femicidal men, failures of the organized church, and failures of the institution of the family. Ten femicides were classified as possibly preventable within the femicidal assault itself. In addition, the interviews with both survivors identified many areas of possible intervention relating to prevention over a longer period of time. The study concludes with my reflections on the process of engaging in research on femicide, discussions about areas for further research and the identification of possible implications for public policy.