Meeting the National Need for Expertise in Pain Management with Clinical Pharmacist Advanced Practice Providers

Seckel, Ellina; Jorgenson, Terri; McFarland, Shawn

doi:10.1016/j.jcjq.2019.01.002

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…Pharmacists in pain management can address access issues. 2,3,11,12 The average length of time from consult to initial visit was 23 days. Often patients may have seen a HCP who implemented a change at the time of consult and wanted the patient to be seen 1 month later.…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, there were just 11 American Society of Health-System Pharmacists-accredited pharmacy postgraduate year 2 pain and palliative care residency programs, which has expanded to 26 sites in 2020. 2,3,25 In addition, 3 The role of pharmacists in prescribing controlled substances is limited mainly due to the small number of states that extend this authority. 7 At the VA, a pharmacist can practice using any state of licensure.…”

Section: Buprenorphine Buccal Film 1mentioning

confidence: 99%

“…For almost 50 years, pharmacists at the US Department of Veterans Affairs (VA) have been functioning as advanced practice providers (APP). 3 Clinical pharmacy specialists (CPS) provide comprehensive medication management (CMM) and have a scope of practice (SOP). The SOP serves as the collaborating agreement and outlines the clinical duties permitted in delivering patient care.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective Chart Review of Advanced Practice Pharmacist Prescribing of Controlled Substances for Pain Management at the Harry S. Truman Memorial Veterans’ Hospital

Kominek

2021

Federal Practitioner

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Background:The US Department of Health and Human Services' 5-point strategy to combat the opioid overdose public health crisis includes improved pain management. There is a shortage of adequately trained health care providers in pain management. Advanced practice pharmacists may be able to help fill that void. The objective of this project was to identify the impact of an advanced practice pharmacist with controlled substance prescriptive authority on morphine milligram equivalent dose (MME) and compliance with opioid risk mitigation.Methods: In March 2020, a single-site retrospective chart review was conducted of patients who were prescribed controlled substances from July 1, 2018 to January 31, 2020. Patients received care through the outpatient Pharmacy Pain Clinic in-person or via telephone who were enrolled at the Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri, or associated outlying outpatient clinics. Patients were included if they were referred to the Pharmacy Pain Clinic and prescribed a Schedule II or III opioid medication. A 2-sided t test was conducted to compare MME, and a Fisher exact test was used to compare adherence to opioid risk mitigation.Results: Patients seen in Pharmacy Pain Clinic had a statistically significant reduction in MME from consult (93 MME) to discharge (31 MME) (P < .01). There was also a statistically significant (P < .01) improvement in use of opioid risk mitigation strategies, including urine drug screen, informed consent, naloxone, prescription drug monitoring program checks, and stratification tool for opioid risk mitigation dashboard reviews. Conclusions: An advanced practice pharmacist with controlled substance prescriptive authority improved patient care with demonstrated statistically significant differences in MME and adherence with opioid risk mitigation from consult to discharge. Health care teams should look to add advanced practice pharmacists to their team as medication experts to deliver comprehensive medication management, which can include controlled substance prescribing and management.

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Section: Discussionmentioning

confidence: 99%

Section: Buprenorphine Buccal Film 1mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective Chart Review of Advanced Practice Pharmacist Prescribing of Controlled Substances for Pain Management at the Harry S. Truman Memorial Veterans’ Hospital

Kominek

2021

Federal Practitioner

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“…A systematic review and meta-analysis showed that pharmacist-led intervention in pain management contributed substantially to pain management, ensuring the rational use of medicine and resulting in reduced pain intensity [ 15 ]. Clinical pharmacists perform pain assessments, assess for substance use disorders, and develop individualized treatment plans in pain management which increase the quality of care [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of adequacy and appropriateness of pain management practice among trauma patients at the Ethiopian Aabet Hospital: A prospective observational study

Ayano,

Fentie,

Tileku

et al. 2023

BMC Emerg Med

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Introduction Pain is unpleasant sensory and emotional experiences associated with actual and/or potential tissue damage. It is the most common and prevalent reason for emergency departments (ED) visits with prevalence over 70% in the world. Aim of the Study The study aimed to assess the adequacy and appropriateness of pain management at Aabet Hospital, Addis Ababa, Ethiopia. Methods A hospital-based prospective cross-sectional study was conducted at Aabet hospital from December 1, 2020 to March 30, 2021. Adult trauma patients having pain (at least score 1 on Numeric Rating Scale) with Glasgow Coma Scale score > 13 were eligible to participate in the study. The pain intensity was evaluated at the time of admission (o minute) and then at 60, 120, 180, and 240 minutes. The time of the first analgesics was registered. The adequacy and the appropriateness of the pain management were calculated through pain management index (PMI). Results Two hundred thirty-two (232) participants were included in this study of which 126 (54.3%) were admitted due to road traffic accident followed by fall 44(19%). Only 21 (9.1%) study participants received the first analgesic treatment within 30 minutes while 27(11.6%) participants had no treatment at all within 240 minutes. The mean pain intensity score at admission was 5.55 ± 2.32 and reduced to 4.09 ± 2.69. Nearly half 110 (47.4%) of the study participants were treated inadequately (PMI (-) score). There was a weak and negative correlation between PMI and time to analgesia (r = − .159, p = 0.0001). The type of analgesia used, the time to analgesia, and the degree of pain may predict 65% of the variance in PMI score (R2 = 0.65, P = .001). Conclusion From the results of this study, it can be concluded that acute pain in trauma patients was under and inappropriately treated.

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“…Pain CMM services and interventions may include optimization of opioid and nonopioid medications, risk mitigation services, and laboratory monitoring and interpretation and referrals for needed care. 16 VVC is an app that connects Veterans and their caregivers from home on any computer, tablet, or mobile device with an internet connection with their VA health care providers through live video. Clinical Video Telehealth requires the Veteran to go to a VA satellite clinic in where the video connection equipment is connected to the VA health care provider and care is provided by telehealth.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist interventions in an outpatient pain clinic at a Veterans Affairs Medical Center

Voll

Brooks

Vartan

et al. 2021

J Am Coll Clin Pharm

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Purpose: Clinical pharmacist practitioners (CPPs) ensure safe and evidence-based pharmacotherapy practices. However, there is little information to date characterizing the impact of pain CPP interventions on patient outcomes within a CPP-managed outpatient chronic and postoperative pain clinic. The primary objective of this study was to classify and quantify the number of pain CPP interventions in the outpatient pain clinic at the West Palm Beach Veteran Affairs Medical Center (WPB VAMC). The secondary objective assessed general patient outcomes associated with pain pharmacotherapy management by a CPP. Summary: A retrospective chart review of pain CPP encounters was utilized to identify interventions over a 12-month period. A total of 805 pain management encounters with a total of 1993 interventions were recorded by pain CPPs during that time. Descriptive statistics and sample size calculations were used to summarize and evaluate results. Overall, 55% of interventions were pharmacological, 45% were nonpharmacological interventions, and 5% were referrals to other specialty providers.For the secondary objective (n = 107), patients in the pain clinic on opioid therapy experienced an average oral morphine equivalent daily dose (MEDD) reduction of 21 mg without any identified suicide or overdose events and achieved on average 45% of their SMART goals by their last visit. In patients with baseline pain, enjoyment of life, and general activity (PEG) scores (n = 69), there were 43% of patients with improved PEG scores at their last visit in which 14% (10/69) experienced a clinically meaningful improvement in PEG scores. Conclusion:Pain CPPs demonstrated a reduction in overall MEDDs safely while following the biopsychosocial approach to pain management by incorporating and referring for nonpharmacological interventions as well as completing opioid risk mitigation. Additional studies are needed to better characterize pain CPP impact on patient outcomes.

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Meeting the National Need for Expertise in Pain Management with Clinical Pharmacist Advanced Practice Providers

Cited by 3 publications

References 31 publications

Retrospective Chart Review of Advanced Practice Pharmacist Prescribing of Controlled Substances for Pain Management at the Harry S. Truman Memorial Veterans’ Hospital

Retrospective Chart Review of Advanced Practice Pharmacist Prescribing of Controlled Substances for Pain Management at the Harry S. Truman Memorial Veterans’ Hospital

Assessment of adequacy and appropriateness of pain management practice among trauma patients at the Ethiopian Aabet Hospital: A prospective observational study

Pharmacist interventions in an outpatient pain clinic at a Veterans Affairs Medical Center

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