Description of a Collaborative, Fee-for-service, Office-based, Pharmacist-directed Medical Cannabis Therapy Management Service for Patients with Chronic Pain

2021 ◽  
Author(s):  
Terrance J. Bellnier ◽  
Geoffrey W. Brown ◽  
Tulio Ortega ◽  
Maria Janda ◽  
Kyle Miskowitz
Keyword(s):  
Chronic Pain ◽  
Management Service ◽  
Fee For Service ◽  
Medical Cannabis ◽  
Therapy Management

scholarly journals Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047717
Author(s):  
Atefeh Noori ◽  
Anna Miroshnychenko ◽  
Yaadwinder Shergill ◽  
Vahid Ashoorion ◽  
Yasir Rehman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Observational Studies ◽  
Prescription Opioids ◽  
Randomised Trials ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Cancer Pain ◽  
Pain Patients

ObjectiveTo assess the efficacy and harms of adding medical cannabis to prescription opioids among people living with chronic pain.DesignSystematic review.Data sourcesCENTRAL, EMBASE and MEDLINE.Main outcomes and measuresOpioid dose reduction, pain relief, sleep disturbance, physical and emotional functioning and adverse events.Study selection criteria and methodsWe included studies that enrolled patients with chronic pain receiving prescription opioids and explored the impact of adding medical cannabis. We used Grading of Recommendations Assessment, Development and Evaluation to assess the certainty of evidence for each outcome.ResultsEligible studies included five randomised trials (all enrolling chronic cancer-pain patients) and 12 observational studies. All randomised trials instructed participants to maintain their opioid dose, which resulted in a very low certainty evidence that adding cannabis has little or no impact on opioid use (weighted mean difference (WMD) −3.4 milligram morphine equivalent (MME); 95% CI (CI) −12.7 to 5.8). Randomised trials provided high certainty evidence that cannabis addition had little or no effect on pain relief (WMD −0.18 cm; 95% CI −0.38 to 0.02; on a 10 cm Visual Analogue Scale (VAS) for pain) or sleep disturbance (WMD −0.22 cm; 95% CI −0.4 to −0.06; on a 10 cm VAS for sleep disturbance; minimally important difference is 1 cm) among chronic cancer pain patients. Addition of cannabis likely increases nausea (relative risk (RR) 1.43; 95% CI 1.04 to 1.96; risk difference (RD) 4%, 95% CI 0% to 7%) and vomiting (RR 1.5; 95% CI 1.01 to 2.24; RD 3%; 95% CI 0% to 6%) (both moderate certainty) and may have no effect on constipation (RR 0.85; 95% CI 0.54 to 1.35; RD −1%; 95% CI −4% to 2%) (low certainty). Eight observational studies provided very low certainty evidence that adding cannabis reduced opioid use (WMD −22.5 MME; 95% CI −43.06 to −1.97).ConclusionOpioid-sparing effects of medical cannabis for chronic pain remain uncertain due to very low certainty evidence.PROSPERO registration numberCRD42018091098.

A Systematic Review of Assessments and Interventions for Chronic Pain in Young Children With or at High Risk for Cerebral Palsy

2021 ◽  
pp. 088307382199691
Author(s):  
Lisa Letzkus ◽  
Darcy Fehlings ◽  
Lauren Ayala ◽  
Rachel Byrne ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Cerebral Palsy ◽  
High Risk ◽  
Online Survey ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Parent Report ◽  
Medical Cannabis ◽  
Nonpharmacologic Intervention

Background: Pain is common in children with cerebral palsy. The purpose of this systematic review was to evaluate the evidence regarding assessments and interventions for chronic pain in children aged ≤2 years with or at high risk for cerebral palsy. Methods: A comprehensive literature search was performed. Included articles were screened using PRISMA guidelines and quality of evidence was reviewed using best-evidence tools by independent reviewers. Using social media channels, an online survey was conducted to elicit parent preferences. Results: Six articles met criteria. Parent perception was an assessment option. Three pharmacologic interventions (gabapentin, medical cannabis, botulinum toxin type A) and 1 nonpharmacologic intervention were identified. Parent survey report parent-comfort and other nonpharmacologic interventions ranked as most preferable. Conclusion: A conditional GRADE recommendation was in favor of parent report for pain assessment. Clinical trials are sorely needed because of the lack of evidence for safety and efficacy of pharmacologic interventions.

scholarly journals Impact of a medication therapy management service offered to patients in treatment of breast cancer

2018 ◽  
Vol 54 (2) ◽  
Author(s):  
Pedro Augusto do Amaral ◽  
Simone de Araújo Medina Mendonça ◽  
Djenane Ramalho de Oliveira ◽  
Leonardo José Peloso ◽  
Reginaldo dos Santos Pedroso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Medication Therapy Management ◽  
Management Service ◽  
Therapy Management ◽  
Medication Therapy

Description of an Established, Fee-for-Service, Office-Based, Pharmacist-Managed Pharmacogenomics Practice

2019 ◽  
Vol 34 (10) ◽  
pp. 660-668 ◽  
Author(s):  
Michael J. Schuh ◽  
Sheena Crosby
Keyword(s):  
Older Adults ◽  
Tertiary Care ◽  
Medication Therapy Management ◽  
Third Party ◽  
Medical Team ◽  
Medical Clinic ◽  
Fee For Service ◽  
Therapy Management ◽  
Medication Therapy ◽  
Ambulatory Practice

OBJECTIVE: To describe an established, pharmacist-managed, fee-for-service, office-based pharmacogenomics (PGx) practice.<br/> SETTING: Multi-specialty, academic, tertiary care medical clinic and hospital.<br/> PRACTICE DESCRIPTION: Physician office-based PGx fee-for-service (FFS) pharmacist practice. Patients seen are complex and most are older adults.<br/> INNOVATION: Established service in a new area of ambulatory practice that is financially self-sustaining. Patients who received PGx testing were seen within the medication therapy management polypharmacy practice since 2015, with the PGx practice becoming official in 2018.<br/> MAIN OUTCOME MEASUREMENTS: Growth of practice, evaluated by referred patient consults ordered per month by providers.<br/> RESULTS: Because of insufficient third-party payment for PGx services, the practice was developed as a selfpay, FFS practice and growing because of patient and provider demand.<br/> CONCLUSION: It is quite possible pharmacists in greater numbers can expand PGx services into ambulatory and inpatient areas they may have never otherwise entered now that PGx has grown in use and relevance. PGx presents additional opportunities and service lines for pharmacists to practice how they were trained and assist them in collaborative integration onto the medical team.

scholarly journals Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis

2018 ◽  
Vol 8 (3) ◽  
pp. 110-115 ◽  
Author(s):  
Terrance Bellnier ◽  
Geoffrey W. Brown ◽  
Tulio R. Ortega
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Randomized Clinical Trials ◽  
New York State ◽  
The United States ◽  
Preliminary Evaluation ◽  
Medical Cannabis ◽  
Image Study ◽  
Post Therapy

Abstract Introduction: Medical cannabis (MC) is commonly claimed to be an effective treatment for chronic or refractory pain. With interest in MC in the United States growing, as evidenced by the 29 states and 3 US districts that now have public MC programs, the need for clinical evidence supporting this claim has never been greater. Methods: This was a retrospective, mirror-image study that investigated MC's effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. The primary outcome was to compare European Quality of Life 5 Dimension Questionnaire (EQ-5D) and Pain Quality Assessment Scale (PQAS) scores at baseline and 3 months post-therapy. The secondary outcomes included comparisons of monthly analgesic prescription costs and opioid consumption pre- and post-therapy. Tolerability was assessed by side effect incidence. Results: This investigation included 29 subjects. Quality of life and pain improved, measured by change in EQ-5D (Pre 36 – Post 64, P &lt; .0001) and change in PQAS paroxysmal (Pre 6.76 – Post 2.04, P &lt; .0001), surface (Pre 4.20 – Post 1.30, P &lt; .0001), deep (Pre 5.87 – Post 2.03, P &lt; .0001), unpleasant (Pre “miserable” – Post “annoying”, P &lt; .0001). Adverse effects were reported in 10% of subjects. Discussion: After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. Large randomized clinical trials are warranted to further evaluate the role of MC in the treatment of chronic pain.

Implementation of a Pilot Pharmacist Testosterone Therapy Management Service

2019 ◽  
Vol 33 (5) ◽  
pp. 654-660 ◽  
Author(s):  
Michael W. Nagy ◽  
Stephanie Gruber ◽  
Macy McConnell
Keyword(s):  
Primary Care ◽  
Replacement Therapy ◽  
Clinical Pharmacist ◽  
Primary Care Providers ◽  
Testosterone Replacement ◽  
Therapeutic Monitoring ◽  
Testosterone Replacement Therapy ◽  
Management Service ◽  
Care Providers ◽  
Therapy Management

Background: Recent literature findings suggest that opportunities exist to optimize testosterone replacement therapy management. Objective: To evaluate the impact of a pilot clinical pharmacist testosterone therapy management service in a Veterans Affairs primary care setting. Methods: A 6-month, single-clinic, prospective cohort quality improvement project included male patients with an active prescription for testosterone. Patients were excluded if they switched primary care providers or were managed by a specialty clinic. After diagnosis, primary care providers had the option of referring patients for clinical pharmacist testosterone replacement therapy management. The project investigated the impact of pharmacist management on adherence to guideline-defined baseline and therapeutic monitoring, prior authorization workload, time saved by primary care providers, and clinical pharmacist interventions. Results: Sixty patients split between pharmacist management (N = 35) and nonpharmacist management (N = 25) cohorts. Monitoring of baseline parameters was significantly improved with clinical pharmacist management (54% vs 20%, P = 0.0006). Improved baseline monitoring decreased prior authorization team workload as requests were approved on the first submission at a higher rate (100% vs 75.4%, P = 0.06). Pharmacist management increased therapeutic monitoring for assessing symptom improvement (96% vs 26%, P < 0.001), monitoring of testosterone levels (96% vs 61%, P = 0.003), and safety monitoring with complete blood counts (100% vs 83%, P = 0.04). A total of 42 pharmacist–patient encounters saved over 600 minutes of primary care provider time. Conclusion: Clinical pharmacist involvement enhances therapeutic monitoring for male hypogonadism leaving room for expansion of clinical pharmacy services within testosterone replacement therapy management.

Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain

2019 ◽  
Vol 20 (7) ◽  
pp. 830-841 ◽  
Author(s):  
Kevin F. Boehnke ◽  
J. Ryan Scott ◽  
Evangelos Litinas ◽  
Suzanne Sisley ◽  
David A. Williams ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Cannabis
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