Purpose The rise in opioid prescribing, often for chronic pain management, resulted in an increased prevalence of opioid use disorder (OUD) throughout the United States, including within the Veterans Affairs (VA) healthcare system. The veteran population has been especially vulnerable to opioid-related harms, but rates of prescribing medications for OUD have been low. Use of care manager models for OUD have increased access to treatment. In this article we provide an overview of a clinical pharmacist care manager (CPCM) model for medications for OUD treatment implemented within the Minneapolis Veterans Affairs Health Care System. Summary A CPCM model for medications for OUD was identified as a care model that would address patient and facility barriers to effective OUD treatment. Pharmacists were integral in program development and implementation and served as the main care providers. An interim evaluation of the program established that the proportion of patients with OUD receiving medications for opioid use disorder (MOUD) had increased, with use of the program resulting in treatment of 109 unique patients during 625 visits. Key program implementation facilitators included the facility leadership establishing increased use of MOUD as a priority area, identification of a physician champion, and a history of successful expansion of clinical pharmacy specialist practice within the VA system. Implementation barriers included factors related to provider engagement, patient identification, and program support. The CPCM model of provision of MOUD expanded the pharmacist role in buprenorphine management. Conclusion The need to increase the number of patients receiving MOUD led to the implementation of a CPCM model. The program was effectively implemented into practice and expanded the availability of MOUD, which allowed patients to access treatment in multiple care settings.
Although LAIA/OAP polypharmacy occurred less frequently than reported in previous literature, this study highlights the need for further research to better understand this prescribing practice.
Our study highlights the role that pharmacists can play in improving access to evidence-based AUD pharmacotherapy, as well as in providing medication education to patients and providers. Long-term prospective research and pharmacoeconomic analysis are needed to determine the sustainability of this service, both at our facility and in other similar practice settings.
Introduction: This study assesses the utilization of antipsychotic therapeutic drug monitoring (TDM) and describes characteristics of appropriate and inappropriate TDM at a state psychiatric hospital.Methods: A retrospective, descriptive review was conducted for antipsychotic TDM completed between December 1, 2009, and June 30, 2011, at a 65-bed adult inpatient extended-care and forensic state psychiatric hospital.Results: One hundred thirty-three (n = 133) antipsychotic serum levels were collected from 44 patients during the study period. Sixty-nine percent (69%) of the TDM were deemed inappropriate, 28% were appropriate, and 3% could not be designated appropriate or inappropriate owing to the lack of information regarding steady-state conditions. The primary reason for inappropriate TDM was lack of documentation with regard to the indication for TDM (n = 79, 59.3%), the intervention following laboratory analysis (n = 88, 66%), or both. Appropriate TDM was associated with a lower laboratory cost for antipsychotic serum level ($48.98 ± $53.49 versus $72.06 ± $51.02, P < .05), lower daily cost of scheduled psychiatric medications ($17.72 ± $23.03 versus $32.26 ± $31.05, P < .05), lower daily cost of total medications ($19.28 ± $24.91 versus $33.82 ± $31.03, P < .05), fewer scheduled psychiatric medications (2.95 ± 1.90 versus 4.04 ± 2.19, P < .01), and fewer total scheduled medications (5.95 ± 3.60 versus 7.60 ± 3.29, P < .05). Inappropriate TDM led to approximately $6,753 in avoidable laboratory costs over a 20-month period.Discussion: Therapeutic drug monitoring is a complex process with many points at which errors may occur. The majority of antipsychotic levels at this state psychiatric hospital were not documented in a way that was clinically useful. Inappropriate TDM was associated with increased laboratory and medication costs.
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