Successful interventions in decreasing oxycodone CR prescriptions within an underserved population

Abstract

By implementing criteria for oxycodone CR prescribing in an innovative, comprehensive, and unified patient-centered practice model, the authors saw a significant decrease in the number of oxycodone CR tablets prescribed per month and also a decrease in total prescriptions per month.

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

“…In the 51 studies included in the scoping review, pharmacists developed, led [37][38][39][40][41][42][43][44][45][46][47][48][49][50] and were part of interdisciplinary teams 47,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] and physician collaborative care models 45,48,[68][69][70][71][72][73][74] in the management of opioids. The pharmacists undertaking these roles were embedded in prescribers' location of practice [40][41][42][43][44]46,[55][56][57]…”

“…37,46 At the practice or organisational level, outcomes detailed the establishment of workflows and embedded protocols. 55,58,67,68 The study design, population sample and evaluation measures and outcomes are tabulated in Table 2. In addition, the focus of activity related to opioids is included and is further elaborated in Table 3.…”

“…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,…”

“…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. 45,46,48,53,56,58,[61][62][63][64]67 The range and details of pharmacist activities and models of care in primary care settings are detailed in Table 3. The activities have been collated into foci or targets for risk mitigation, with details of pharmacists' activities and roles described.…”

“…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.…”