“We Need to Taper.” Interviews with Clinicians and Pharmacists About Use of a Pharmacy-Led Opioid Tapering Program

Abstract

Objective To identify factors that influence or interfere with referrals by primary care providers (PCPs) to a pharmacist-led telephone-based program to assist patients undergoing opioid tapering. The Support Team Onsite Resource for Management of Pain (STORM) program provides individualized patient care and supports PCPs in managing opioid tapers. Design Qualitative interviews were conducted with referring PCPs and STORM staff. Interview guides addressed concepts from the RE-AIM framework, focusing on issues affecting referral to the STORM program. Setting An integrated healthcare system (HCS) in the Northwest United States. Subjects Thirty-five interviews were conducted with 20 PCPs and 15 STORM staff. Methods Constant comparative analysis was used to identify key themes from interviews. A codebook was developed based on interview data and a qualitative software program was used for coding, iterative review, and content analysis. Representative quotes illustrate identified themes. Results Use of the STORM opioid tapering program was influenced by PCP, patient, and HCS considerations. Factors motivating use of STORM included lack of PCP time to support chronic pain patients requiring opioid tapering and the perception that STORM is a valued partner in patient care. Impediments to referral included PCP confidence in managing opioid tapering, patient resistance to tapering, forgetting about program availability, and PCP resistance to evolving guidelines regarding opioid tapering goals. Conclusions PCPs recognized that STORM supported patient safety and reduced clinician burden. Utilization of the program could be improved through ongoing PCP education about the service and consistent co-location of STORM pharmacists within primary care clinics.

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

“…Pharmacists often work in interdisciplinary care teams and make recommendations to both providers and patients about pharmacologic and non-pharmacologic interventions, including pain management ( 64 – 66 ). Given an important role of pharmacists in opioid stewardship and prevention of future opioid crisis ( 67 , 68 ), we hypothesize here that pharmacists recommendations to integrate digital therapeutics with opioid-based analgesia will improve outcomes of opioid tapering programs ( 69 – 73 ). Recently, the Academy of Managed Care Pharmacy convened a forum that brought digital therapeutic innovators, payers, pharmacy benefit managers, and other key stakeholders to discuss the role of digital interventions as therapeutic options ( 74 ).…”

“I really had somebody in my corner.” Patient experiences with a pharmacist-led opioid tapering program

“…Detailed descriptions of the STORM program have been reported previously. 11,14,15 At the time of our interviews, the STORM team consisted of 8 clinical pharmacists, 1 pain medicine physician, and 1 social worker. Our study is part of a mixed-methods evaluation of the STORM program guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.…”

“…PCPs have reported stress and burnout related to caring for patients requiring opioid tapers. [8][9][10][11][12] Pharmacists can support both PCPs and patients with the process of opioid tapering, thus alleviating the burden on PCPs and increasing patient engagement. 10,11,13 However, little is known about the factors that determine patient acceptability and success with opioid tapering programs generally; even less is known about patient perspectives on programs led by pharmacists.…”

A Pharmacist-Assisted Initiative to Improve Chronic Pain Management and Reduce Opioid Use in Primary Care

“…[17][18][19] Since the 2016 CDC Guidelines, the climate for proactive assistance from pharmacists has changed, as there are many primary care providers who are motivated to reassess their care of CNMP and their concomitant prescribing of opioids, but feel they lack the necessary training or time to do so. 20 In this paper we report the results of a quality-improvement project designed to improve management of CNMP in the primary care setting. By partnering a motivated primary care provider with a clinical pharmacist, we developed a relatively accessible strategy to minimize opioid use, improve management of CNMP, and maintain positive patient/provider relationships.…”

“…17 - 19 Since the 2016 CDC Guidelines, the climate for proactive assistance from pharmacists has changed, as there are many primary care providers who are motivated to reassess their care of CNMP and their concomitant prescribing of opioids, but feel they lack the necessary training or time to do so. 20 …”