Pharmacy multidisciplinary stewardship program for high-risk patients prescribed opioids in an academic clinic

Yvette Hellier, PharmD; Machelle Wilson, PhD; Angela Leahy, PharmD; Kevin Burnham, MD

doi:10.5055/jom.2020.0589

Authors

Yvette Hellier, PharmD
Machelle Wilson, PhD
Angela Leahy, PharmD
Kevin Burnham, MD

DOI:

https://doi.org/10.5055/jom.2020.0589

Keywords:

controlled substance, internal medicine, pharmacy, opioid stewardship

Abstract

Objective: To assess observation of the Centers for Disease Control (CDC) Guideline for prescribing opioids for chronic pain within a Pharmacy Controlled Substance Clinic (PCSC) compared to usual care by resident physicians in a Primary Care Internal Medicine (IM) clinic.

Design: Single-center, retrospective cohort.

Setting: IM clinic within a large, academic medical center.

Participants: Patients receiving stable opioid prescriptions for management of chronic nonmalignant pain (CNCP) were screened. Exclusions included age < 18 years old, aberrant opioid use behaviors, or malignancy-related pain. Both cohorts included 100 eligible patients.

Interventions: Within the PCSC, a pharmacy team provided assistance to resident physicians monitoring patients receiving opioid medications.

Main Outcome Measures: The primary outcome was application of CDC guidelines: creation of an annual patient provider agreement (PPA); annual urine drug screen (UDS); quarterly review of a prescription drug monitoring program (CURES); and documentation of quarterly evaluation of opioid use. Secondary outcomes included risk factors for opioid-related harms.

Results: Respective measures from the control versus the intervention group demonstrated: PPA creation in 28 percent (n = 28) versus 100 percent (n = 100) (p < 0.001); UDS obtained in 59.2 percent (n = 58) versus 90.6 percent (n = 87) (p < 0.001); quarterly CURES review in 26 percent (n = 26) versus 70 percent (n = 70) (p < 0.001); and quarterly evaluation of opioid use in 26 percent (n = 26) versus 37 percent (n = 37) (p = 0.10).

Conclusions: Pharmacy-led monitoring of patients prescribed opioids for CNCP in an academic resident clinic improves implementation of CDC guidelines. Similar multidisciplinary team integration may improve opioid prescribing safety in academic primary care settings.

Author Biographies

Yvette Hellier, PharmD

Pharmacy, University of California, Davis Health, Sacramento, California

Machelle Wilson, PhD

Public Health Sciences, University of California, Davis Health, Sacramento, California

Angela Leahy, PharmD

Pharmacy, Sutter Health, Sacramento, California

Kevin Burnham, MD

Internal Medicine and Sports Medicine, University of California, Davis Health, Sacramento, California

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