Evaluating outcomes of a clinical pharmacist medication management program in a multidisciplinary practice for outpatient buprenorphine treatment of opioid use disorder

Abstract

IntroductionTreatment with medications such as buprenorphine has been shown to improve outcomes of patients with opioid use disorder (OUD); however, there is still potential to optimize care. Clinical pharmacists may benefit OUD patient treatment by making individualized medication recommendations and enhancing care as part of a multidisciplinary team. This study evaluates a novel outpatient practice model that incorporates pharmacists to manage OUD patients.MethodsA multi‐center retrospective study compared outcomes of a multidisciplinary practice with clinical pharmacists to a physician‐only practice. Primary outcomes were treatment retention and opioid relapse rate. Secondary outcomes included patient engagement with counseling, toxicology results, and buprenorphine nonadherence. Data were collected from 75 patient records from each practice for up to 1 year after starting treatment. In addition, a prospective, observational study was conducted to describe pharmacist interventions at the multidisciplinary practice. Twenty patients were followed for up to 1 year to characterize pharmacist recommendations and assess treatment retention and opioid relapse rates among other secondary measures.ResultsIn the retrospective study, treatment retention did not differ between practices (P > .05) but multidisciplinary practice patients experienced fewer opioid relapse months (P < .05). Similar rates of engagement with counseling (P = 1) and follow‐up visits with illicit substance use (P > .05) were observed. More buprenorphine nonadherence was identified at the physician practice (P < .01). In the prospective study, pharmacist recommendations included buprenorphine regimen changes and the addition of new medications for un/undertreated conditions. Pharmacists provided care coordination, medication counseling, non‐pharmacologic recommendations, and counseling regarding future/alternative treatment options.ConclusionThis study demonstrates the ability of a practice with clinical pharmacists to provide quality care to OUD patients in an outpatient setting. These results have implications for OUD treatment by expanding addiction services in this underserved patient population.

Pharmacist‐delivered comprehensive medication management in a substance use disorder clinic, an 18‐month descriptive study

“…Mattle et al reported 185 medication interventions at 232 initial and follow‐up visits in an outpatient buprenorphine practice setting, which translated to 0.8 interventions per encounter and was consistent with the number of MTPs identified per visit in this study 15 . At the follow‐up visits of this study, 54/201 MTPs (27%) were marked as “resolved.” Other MTPs may have been resolved, but could not be verified due to a lack of client follow‐up to confirm.…”

“…In another study in a community setting, patients who received medication therapy management intervention had a lower rate of continued opioid misuse at 3 months, and better pain and depression scores 18 . For outpatient buprenorphine treatment, participants receiving multidisciplinary practice with clinical pharmacists had fewer opioid relapse months 15 . Delivering comprehensive medication management (CMM) services utilizing a patient‐centered approach to optimize treatment is a role that pharmacists can take to improve health outcomes given that patients with SUD usually have co‐occurring mental illnesses or other comorbidities.…”

“…Besides ensuring medication access, risk identification, increasing naloxone dispensing, referral to treatment and support resources, and stigma elimination, clinical pharmacists have expanded their roles with more opportunities to optimize medication therapy for patients with SUD 6,12–14 . Research has shown that pharmacist‐delivered medication management helped improve retention rate, adherence, and reduce health care costs for patients with SUD in various ambulatory care settings 15–17 . DiPaula et al reported that the drug therapy management model conducted by pharmacists showed a 100% 6 month‐retention rate, and 98% adherence with a sample size of 12 patients receiving buprenorphine treatment.…”

Impact of medication optimization and recommendations by clinical pharmacists embedded in a memory disorder clinic

“…Patients were evaluated in-person by a pharmacist and recommendations were discussed and communicated contemporaneously with the treating provider by face-to-face conversation, instant message, and/or chart message. 45 It is possible that the recommendation acceptance rate in the present study may have improved synergistically with direct patient contact and concurrent provider communication.…”

“…Interestingly, a previous study conducted at the same outpatient neurology center as the present study evaluated outcomes of a clinical program which made use of pharmacists who were physically embedded within a psychiatry practice and found that 89% of medication recommendations were accepted by treating providers. Patients were evaluated in‐person by a pharmacist and recommendations were discussed and communicated contemporaneously with the treating provider by face‐to‐face conversation, instant message, and/or chart message 45 . It is possible that the recommendation acceptance rate in the present study may have improved synergistically with direct patient contact and concurrent provider communication.…”