Pharmacy multidisciplinary stewardship program for high-risk patients prescribed opioids in an academic clinic

Hellier, Yvette; Wilson, Machelle; Leahy, Angela; Burnham, Kevin

doi:10.5055/jom.2020.0589

Cited by 1 publication

(10 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the 51 studies included in the scoping review, pharmacists developed, led [37][38][39][40][41][42][43][44][45][46][47][48][49][50] and were part of interdisciplinary teams 47,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] and physician collaborative care models 45,48,[68][69][70][71][72][73][74] in the management of opioids. The pharmacists undertaking these roles were embedded in prescribers' location of practice [40][41][42][43][44]46,[55][56][57]…”

Section: Resultsmentioning

confidence: 99%

“…In the majority of studies, the outcome of interest for the patient cohorts was any change to opioid doses prescribed, in the context of reducing risk from high opioid doses in CNCP. 38,40,51,53,55,56,61,63,67,74,76,82 For comparative studies, the opioid load was most often estimated by converting it to the oral morphine equivalent daily dose, or oMED, a method to standardise the dose based on the knowledge that different opioids with varying potency may produce a similar analgesic effect. 88 Additional outcomes included the impact of any change to oMED or pharmacist involvement on symptom scores and functionality, 47,48,52,57,69 which were also outcomes for the four palliative care studies.…”

Section: Resultsmentioning

confidence: 99%

“…Opioid load targeted • Development and implementation of safety initiatives and stewardship models in collaborative interdisciplinary teams 56,[61][62][63][64]67,74 with provision of support for prescribers of high doses 48 • Collaborative development of pain management protocols 53,58 and controlled substance agreements 58 • Face-to-face and remote medication review and risk assessment 37,57 care plans and recommendations for risk reduction 40,57 • Opioid dependence targeted through implementation of pharmacist-independent prescriber clinics 83 • Provision of direct patient care in collaborative care models 45,51,69 and collaborative prescribing 73 Initiation of electronic alerts to prescribers in patient records 75 • Supervision of individualised opioid tapers as member of integrated pain management team 55 • Review after prescriber referrals to pharmacists in specialised pain service, 47 pharmacist teaching clinic 76 and academic detailing by clinical pharmacists 82 • Review, risk screening and change to opioid doses, formulations and recommended analgesics for palliative care clinic outpatients 49,65,66 Symptom management • Pharmacists as member of population-level opioid safety and pain management initiative, incorporating education, training and implementation 56 and controlled substance committee 61 • Review and recommendations in palliative care clinics for management of pain and adverse medication effects in person 49,65,66 or via phone, 84 including via collaborative practice model of care 72 • Direct patient care in collaborative models of pain management 45,47,…”

Section: Focus Of Activity Description Of Pharmacist Activitymentioning

confidence: 99%

“…• Pharmacists as members of controlled substance committees and safety initiatives, with policy, education and recommendations for uptake 61,63,64,74 • Facilitated uptake in specialised pain and rehabilitation teams 51,55 and collaborative pharmacist/nurse practitioner prescription clinic 71 • Recommendations for uptake after remote review of electronic records 37 or clinic patients 85 • Academic detailing of key messages to promote behaviour changes of prescribers 87 Take-home naloxone (THN) uptake…”

Section: Focus Of Activity Description Of Pharmacist Activitymentioning

confidence: 99%

“…• Recommendation from specialist pain services face-to-face or via telehealth, 55 or after electronic consultation 54 • Developed care plans and risk reduction recommendations for high-risk patients as embedded pharmacist 40 • Alerts added to patient records for prescribers after electronic review by co-located pharmacist 75 • Pharmacists as members of controlled substance committees and safety initiatives, with policy, education and recommendations to target combination 61,63,64,74 • Prescribers of high doses or risky combinations supported to taper doses through organisation opioid safety initiative 48 • Developed drug utilisation review activity with correspondence to combination prescribers as the intervention 79 • Correspondence to combination prescribers in health systems, via email or facsimile, with recommendations 62,80 • Correspondence to prescribers of combinations from community pharmacy practice 78 • Review and recommendations for high-risk patients identified in community pharmacy practice 85 Medication-assisted treatment…”

Section: Focus Of Activity Description Of Pharmacist Activitymentioning

confidence: 99%

See 4 more Smart Citations

Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities

Jordan

Latif

Mullan

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.

show abstract