Brief intervention medication therapy management: Establishment of an opioid misuse intervention model delivered in a community pharmacy

Abstract

Purpose Medication expertise and close patient contact position community pharmacists to make significant contributions to combatting the opioid epidemic. This position facilitated the development and initial implementation of the Brief Intervention Medication Therapy Management (BIMTM) model to detect and address patient opioid misuse. BIMTM is an intervention consisting of 9 sessions. One medication management session is delivered by a pharmacist in a community pharmacy setting, and the remaining sessions are delivered telephonically by a patient navigator to follow up with goals established with the pharmacist and address concomitant health concerns that increase risk for misuse. Methods We employed the Consolidated Framework for Implementation Research (CFIR) to summarize and present key findings from 4 distinct studies. CFIR domains addressed were (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) process, and (5) characteristics of individuals. The study results show sequential development of evidence for BIMTM. Results A multistate cross-sectional pharmacist survey (n = 739) demonstrated limited pharmacist training and/or resources to address misuse, suggesting the need for external intervention development. Our multistakeholder intervention planning project showed limitations of current evidence-based models of care and of intervention implementation, which resulted in construction of the BIMTM. A multisite cross-sectional screening survey of patients (n = 333) established an electronic misuse screening protocol within 4 community pharmacies and identified opioid misuse in 15% of screened patients; among those patients, 98% had concomitant health conditions that contribute to the risk of opioid misuse. Presentation of study results to pharmacy leaders produced commitment for intervention implementation and a partnership to develop a grant proposal supporting this action. Our small-scale randomized trial evinced success in recruitment and retention and BIMTM patient benefit. The small-scale randomized trial likewise showed high levels of satisfaction with BIMTM. Conclusion The establishment of BIMTM supports community pharmacist identification and intervention with patients engaged in misuse. Continued use of this research-based strategy may further empower pharmacists to address the opioid epidemic.

A scoping literature review of pharmacy-based opioid misuse screening and brief interventions

“…Five of the six intervention studies 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 (all except Ref ID 3) were rated high on all three factors: validity, reliability, and applicability. These studies had clear descriptions of appropriate methods and outcomes and used standardized instruments (validity), had sufficient sample sizes, and reported significant statistics (reliability), and had a clearly described SBI that could be used for future research (applicability).…”

“…Of the 24 records included in the qualitative synthesis, only six were intervention-based studies (Ref ID 1–6). 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 Two of these studies by Cochran et al involve the same intervention initially evaluated in a small-scale randomized control trial (RCT) (Ref ID 1) 21,22 with a larger active-control RCT (Ref ID 2) currently underway. 24 They used the Prescription Opioid Misuse Index as a screener and conducted motivational interviewing, counseling, medication therapy management, and naloxone navigation as brief interventions, with referral to treatment.…”

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

“…The authors developed the Brief Intervention Medication Therapy Management (BIMTM) model, through which pharmacists play a key role in reducing medication misuse among their patients in the community. 39 …”

“…The authors developed the Brief Intervention Medication Therapy Management (BIMTM) model, through which pharmacists play a key role in reducing medication misuse among their patients in the community. 39 Education of pharmacists, collaborative practice agreements, and sustainable payment models would facilitate successful long-term practice integration. 19 Callister et al evaluated interprofessional clinician experiences with an inpatient addiction consultation service in a Colorado hospital using focused groups and interviews.…”

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

“…Independent and chain pharmacies currently have the capacity to host brief targeted interventions (≤15 minutes), like screening, brief intervention, and referral to treatment (SBIRT), provided to patients at the point of care-which could focus on prevention of misuse of controlled substances, initiation of MOUD, provision of naloxone, sterile syringes, and point of care testing equipment for illicit drugs, and/or referral to MOUD providers. 85,86 If interventions or medication counseling services require greater time (>15 minutes), these likely must be delivered out of workflow and may require appointments either in person or via telecommunication. In both cases, in the current practice environment, researchers will likely need to provide additional resources to offset loss of productivity caused by pulling pharmacists away from dispensation duties, additional pharmacists to perform research duties, or delegation of tasks to pharmacy technicians, depending on state scope of practice policies.…”