Table 6 Barriers for research evidence engagement in pharmacist prescriptive authority

Individual barriers: innate barriers that prevent the individual from utilizing research evidence

 Lack of skill set

Lack of ability to translate research into actionable policy

“I think the big, I guess, the barriers if I had to call them out or kind of get at how the model is going to be translated, are going to have different workflow challenges, they’re going to again have different capacity challenges. I think the big part wasn’t so much developing the protocol as the work that’s happening, literally right now it’s how does that protocol gets translated.”

“…the barrier to using real research is that it is difficult for the average person to understand.”

 Lack of time

Inability to designate enough time

“…how much lead time you give yourself with regard to crafting legislation, you know, that I can think of a couple of other bills that I've worked on for over a period of time where you do kind of have a little bit of space to be able to use the expertise of researchers. But in this instance, I did not have [that time].”

Contextual barriers: factors outside of the individual’s or organization’s influence that prevent utilization of research evidence

 Research was not there

Applicable research was not available at the time to guide policy

“It’s still relatively new. So we were one of the first, you know, handful of states to actually implement the policy…sometimes policy get ahead of where research is, yeah, and so, you know, that potential obstacle.”

“…sometimes there’s not great data. You know, the studies are small so they have their study limitations, all the same ones we always hear, studies small, you know, not enough numbers in power, you know …you know, it wasn’t…it wasn’t the double-blinded double.”

 External stakeholder opposition

External opposition led to compromised practice

“So turf battles with medicine is pretty popular opposition that we face for a lot of these … So that’s probably, you know, that sticks out in my mind sort of the first—the first and most prominent of the hurdles that we face because we face it every time we—every time we try to do this.”

 Lack of value

Research evidence was not as highly valued as other considerations

“Some of them like research but most of them like anecdotal stories, so if you can get somebody to come in and say ‘I overdosed on this and I wish someone gave me naloxone and revived me’, that’s a good story. Works better than hard research sometimes.”

 Catalyst did not exist

Pharmacists were the “logical” solution

“It was looked at as a pretty common-sense approach to allow pharmacists to prescribe, you know, what is, you know, pretty universally seen as a safe medication… I don’t know if there would really be able to point to much that I would say that this is what really drove it home or anything else.”

The urgent need for the policy outweighed research use

“There wasn’t a lot to research at the time, and the value of developing the policy importance is still…important that we do it. That’s not fair, but it’s what I feel.”

“…prescriptive authority for oral contraceptives or prescriptive authority for smoking cessation products and that, I mean, you know, we can we can make some… arguments for and against that…but when you look at naloxone specifically, I mean, the goal here is to save people’s lives, you know, in that respect, and take care of an epidemic that was…you know, we’re right in the middle of, so it just was not a controversial item.”