Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study

Abstract

Background More than 70% of patients continue to use opioid medications 3-weeks following total knee arthroplasty. Post-discharge pharmacist reviews improve medication management, however it’s effect on opioid usage is not known. Aim This study aimed to evaluate the impact of post-discharge pharmacist review on opioid use following a total knee arthroplasty. Method A pilot, cohort pre- and post-intervention study was undertaken on patients who had undergone a total knee arthroplasty and were supplied an opioid upon discharge from hospital. During the intervention, patients were contacted via telephone by a pharmacist approximately five days post-discharge to review analgesic usage, provide education and advice and communicate an opioid management plan to their general practitioner. The primary endpoint was the percentage of patients taking opioids 3-weeks post-discharge. Secondary endpoints included: percentage of patients obtaining an opioid refill; patient satisfaction with opioid supply and the pharmacist review. Results Pre- and post-intervention, 63 and 44 patients were included, respectively. The percentage of patients taking opioids 3-weeks post-discharge declined from 74.6 to 29.6% ( p < 0.001) and the percentage requiring an opioid refill from their general practitioner declined from 71.4 to 36.4% ( p < 0.001). More patients were satisfied with opioid supply during the intervention period (79.5% cf. 47.6%, p = 0.001). Twenty-eight (63.6%) patients could recall the post-discharge pharmacist review, and all were either satisfied or extremely satisfied with the review. Conclusion Pharmacist-delivered post-discharge analgesia review reduced the percentage of patients taking opioids 3-weeks post-discharge following a total knee arthroplasty. This intervention has the potential to provide a smoother transition of care for patients supplied with opioids at the time of hospital discharge.

Standard of practice in pain management for pharmacy services

“…27 In a separate study at an Australian hospital, post-discharge review by a pharmacist was found to reduce the proportion of patients taking opioids three weeks following discharge. 28 In another Australian study, pharmacist-led, inpatient opioid de-escalation demonstrated a significant reduction in opioid use and constipation without adversely affecting patient-reported pain control. 29 In the United Kingdom and the United States of America, implementation of pharmacist prescribing improved opioid risk management and de-escalation.…”

“…Further, pharmacist review of discharge prescriptions from surgical wards has been shown to reduce the proportion of patients supplied with opioids 27 . In a separate study at an Australian hospital, post‐discharge review by a pharmacist was found to reduce the proportion of patients taking opioids three weeks following discharge 28 . In another Australian study, pharmacist‐led, inpatient opioid de‐escalation demonstrated a significant reduction in opioid use and constipation without adversely affecting patient‐reported pain control 29 .…”

“…Examples of pain management pharmacist research include: Post‐discharge pharmacist opioid review following total knee arthroplasty 28 Comparison of the risks and benefits of immediate‐ and modified‐release oral opioids 18 Impact of pharmacist‐led opioid de‐escalation 29 Evaluating adherence to postoperative opioid prescribing guidelines and patient outcomes 58 Persistent opioid use after hospital discharge 14 Impact of junior doctor education on rates of opioid prescribing at discharge 20 Appropriateness of gabapentinoid prescription for surgical and trauma pain in gabapentinoid‐naive patients 59 Off‐label use of lignocaine transdermal patches for pain conditions 60 …”

Team Approach: Use of Opioids in Orthopaedic Practice

“…In a recent statement, the American Academy of Orthopaedic Surgeons stressed the need for a comprehensive opioid program to reduce opioid use, misuse, and abuse in the United States 13 . They specifically emphasized the importance of collaboration among all physicians and caregivers to ensure the safest and most effective treatment and management of pain 2,14,15 . This review aimed to describe a practical interdisciplinary approach for 1) screening and identifying at-risk patients and 2) providing appropriate interventions to opioid-treated patients undergoing orthopaedic surgery.…”