Pharmacists Can Assist Providers With Safe Opioid Prescribing Practices

According to a new study, including pharmacists in a team-based care model to treat patients with chronic pain can help primary care physicians (PCPs) create a plan to safely prescribe opioids to this population.

The study, published in the Journal of the American Board of Family Medicine, included 45 patients, who mostly had multiple documented pain diagnoses. The most common diagnosis was unspecific joint pain.

“PCPs are often the first contact for patients with chronic pain; however, PCPs often feel that these patients are challenging to manage, and practice patterns, documentation, and compliance with opioid prescribing guidelines vary widely,” the authors noted.

The study analyzed the impact of a pharmacist-led intervention at a family medicine residency clinic on managing chronic pain. The initiative included a previsit pharmacist review of patients aged 18 years or older with appointments for chronic pain.

The pharmacists reviewed the patients with upcoming provider appointments for chronic pain each week. The review included an outline of the patient’s current pharmacotherapy plan and recommendations for optimizing the patient’s pain management. The information was documented in the electronic health record and sent to the provider. The pharmacist and provider discussed the recommendations verbally on the day of the appointment when possible. Ultimately, implementation of the intervention recommendations was deferred to the prescriber.

After 4 months, the study’s primary outcomes—mean morphine milligram equivalents (MMEs) per day and pain scores—were analyzed and compared with data collected at the beginning of the program. By the end of the initiative, the mean MME per day based on prescriptions had decreased by 17% and the mean MME per day based on number of pills prescribed per month was down 14%. There was no statistically significant change in mean pain scores.

The recommendations most commonly provided by the pharmacist to the PCP were to initiate/change to a nonopioid analgesic therapy, consider an opioid taper, refer the patient to a pain specialist, and offer an outpatient naloxone prescription. The recommendations that were most commonly implemented were to offer an outpatient naloxone prescription, taper opioid therapy, and initiate/change nonopioid analgesic therapy.

“We hypothesize that this pharmacist engagement model can be applicable to a wide variety of primary care settings,” the authors concluded. “Future studies should seek to validate the results of this study on a larger scale.”

References

Cox N, Tak CR, Cochella SE, Leishman E, Gunning K. Impact of pharmacist previsit input to providers on chronic opioid prescribing. J Am Board Fam Med. 2018;31(1):105-112. doi: 10.3122/jabfm.2018.01.170210.