Implementation of a pharmacist care manager model to expand availability of medications for opioid use disorder

Abstract

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.

Four models of pharmacist‐integrated office‐based opioid treatment

“…4,29 Pharmacist involvement in OBOT offers many benefits including increased number of appointments, reducing physician burden, increasing community involvement, decreasing cost, and increasing medication adherence. [5][6][7][8][9][10] The majority of pharmacist activities described here encompass core elements of OBOT appointments, specifically around the assessment of safe and effective use of the buprenorphine. In comparison to current literature, these four pharmacists utilize the same covisit model whereby the pharmacist completes the medication management portion of the office visit with the physician, thereby maximizing the physician time and increase clinic productivity and financial revenue.…”

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

“…Pharmacists in Australia, Canada, and Europe have contributed to the treatment and care of OUD patients over the decades ( Cochran et al, 2020 ). Nonetheless, OUD medications are often underutilized due to barriers which limit access to care ( DeRonne et al, 2021 ). These barriers to care increased during the pandemic, which is why pharmacists’ ability to provide continuity of care is so critical.…”

Role of the pharmacist in acute care interventions for opioid use disorder: A scoping review

“…Examples include pharmacist-led programs to improve commonly co-occurring infectious disease screening 29,30 and complex medication management. 31 The pharmacist-led pain consult team 24 provides a unique example that could be expanded into other domains, including pharmacist-led psychiatric and infectious diseases consult services. In addition, continued medication access beyond the ED visit or hospital admission is crucial to preventing relapse and maintaining patient engagement in treatment.…”