Impact of pharmacist-led medication assessments on opioid utilization

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

“…Outcomes from pharmacist consultations included assessments of pain, depression, disability, function, potential risks of opioids and development of care plans. 40,45,47,48,52,65,69,76,85 These concur with the recommendation from the Centers for Disease Control and Prevention (CDC) 2016 guidelines for prescribing opioids for chronic pain, which is to establish patient and prescriber goals for functional (physical, social and emotional) improvement and not purely for pain. 29 The outcome for three studies in the review was a reduction in opioid use without significant change in the patient-reported outcomes of pain, depression or disability, 48,57,69 thus potentially reducing harm from opioids without adversely or otherwise affecting function.…”

“…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.…”

“…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,…”

“…In many studies, pharmacists were actively involved in patient management and received direct referrals or prescribed independently. 39,45,51,62,72,74,76,[83][84][85] In studies where pharmacists were not directly involved in patient care, recommendations for opioid management were provided based on patient records 75 or with education of prescribers to encourage behaviour change. 82,86,87 Examples of pharmacists initiating, developing or having input into policies and protocols at the organisational level and effecting system-wide change were included in the results.…”

“…Activities initiated in hospitals have included prescriber education, 'de-escalation' of opioids following surgery and embedding systemic changes to improve prescribing at the time of handover from hospital and transitions of care. [90][91][92][93][94] For patients with CNCP, significant findings were realised in reducing the burden of opioid prescribing using the oMED 40,47,48,51,53,[55][56][57]61,63,65,67,74,76 and prescribing rates 37,54,58,62,64,80 as measures, but also for the patient-reported outcomes of pain and functionality.…”