scholarly journals Outcomes Associated With Pharmacist- Led Consult Service for Opioid Tapering and Pharmacotherapy

2021 ◽  
Author(s):  
Michelle Krichbaum
Keyword(s):  
Consult Service ◽  
Opioid Tapering

scholarly journals Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jason W. Busse ◽  
Joyce Douglas ◽  
Tara S. Chauhan ◽  
Bilal Kobeissi ◽  
Jeff Blackmer
Keyword(s):  
Online Survey ◽  
Preliminary Evidence ◽  
Opioid Therapy ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Opioid Tapering ◽  
Noncancer Pain

Background. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results. We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion. There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

How Do You Know Your Consult Service is Doing a Good Job? Generating Performance Measures for C-L Service Effectiveness

2013 ◽  
Vol 54 (6) ◽  
pp. 567-574 ◽  
Author(s):  
Mallika Lavakumar ◽  
Emily D. Gastelum ◽  
Filza Hussain ◽  
Jon Levenson ◽  
Ralph N. Wharton ◽  
...  
Keyword(s):  
Performance Measures ◽  
Consult Service ◽  
Service Effectiveness

A pharmacist-managed virtual consult service to improve tuberculosis screening

2021 ◽  
Author(s):  
Veranika Sasnovskaya ◽  
Lisa M Kumor ◽  
JoAnn Stubbings ◽  
Aimee Chevalier
Keyword(s):  
Adverse Events ◽  
Safety Management ◽  
Consult Service ◽  
Practice Model ◽  
Tuberculosis Screening ◽  
Serious Adverse Events ◽  
Pharmacy Benefit ◽  
Serious Infections ◽  
Biologic Response ◽  
Specialty Pharmacy

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe a pharmacist-managed virtual consult service practice model to improve medication safety in a population of rheumatology patients and evaluate its initial impact on guideline compliance. Summary Optimal pharmacologic care of patients with rheumatologic conditions often revolves around the use of specialty medications such as self-injectable biologics and infused therapies, including biologic response modifiers (BRMs), nearly all of which carry risks of serious adverse events due to their immune-suppressive properties. Possible adverse events include serious infections such as reactivation of tuberculosis (TB) and viral hepatitis B (HBV). This articles describes a pharmacist-managed virtual consult service introduced by a large university-affiliated health system in 2018 to integrate clinical, specialty pharmacy, and therapeutic infusion services for proactive medication and safety management for patients with rheumatologic conditions requiring specialty or infused medications. During a 4-month evaluation period, 157 referrals were sent to the consult service; of 137 consults included in the analysis, 42% were for self-injectable biologic medications, 28% were for intra-articular injections, 26% were for infusions, and 4% were for oral specialty medications. Forty-one percent of the pharmacy benefit consult orders required an intervention prior to submission of prior authorization requests. Most interventions (61%) were clinical in nature and involved the pharmacists ensuring that necessary laboratory work, clinical disease activity scoring, or radiographic imaging were completed prior to submission of the consult results for insurer approval. Conclusion National rates of HBV screening and TB screening for patients prescribed BRMs continue to be suboptimal. The pharmacist-managed virtual consult service is a novel practice model to increase the screening rate to 100% to ensure the safety and appropriate monitoring of patients who are starting or continued on these complex medications.

scholarly journals Addressing Inpatient Glycaemic Control with an Inpatient Glucometry Alert System

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
J. N. Seheult ◽  
A. Pazderska ◽  
P. Gaffney ◽  
J. Fogarty ◽  
M. Sherlock ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Length Of Stay ◽  
Point Of Care ◽  
Inpatient Mortality ◽  
Consult Service ◽  
Alert System ◽  
Microsoft Excel ◽  
Significant Change ◽  
Weighted Values

Background. Poor inpatient glycaemic control has a prevalence exceeding 30% and results in increased length of stay and higher rates of hospital complications and inpatient mortality. The aim of this study was to improve inpatient glycaemic control by developing an alert system to process point-of-care blood glucose (POC-BG) results.Methods. Microsoft Excel Macros were developed for the processing of daily glucometry data downloaded from the Cobas IT database. Alerts were generated according to ward location for any value less than 4 mmol/L (hypoglycaemia) or greater than 15 mmol/L (moderate-severe hyperglycaemia). The Diabetes Team provided a weekday consult service for patients flagged on the daily reports. This system was implemented for a 60-day period.Results. There was a statistically significant 20% reduction in the percentage of hyperglycaemic patient-day weighted values >15 mmol/L compared to the preimplementation period without a significant change in the percentage of hypoglycaemic values. The time-to-next-reading after a dysglycaemic POC-BG result was reduced by 14% and the time-to-normalization of a dysglycaemic result was reduced from 10.2 hours to 8.4 hours.Conclusion. The alert system reduced the percentage of hyperglycaemic patient-day weighted glucose values and the time-to-normalization of blood glucose.

Opioid tapering in patients with prescription opioid use disorder: A retrospective study

2017 ◽  
Vol 17 (1) ◽  
pp. 167-173 ◽  
Author(s):  
Kehua Zhou ◽  
Peng Jia ◽  
Swati Bhargava ◽  
Yong Zhang ◽  
Taslima Reza ◽  
...  
Keyword(s):  
Trigger Point ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Office Visits ◽  
Opioid Use ◽  
Clinical Practices ◽  
Medication Assisted Treatment ◽  
Opioid Tapering ◽  
Prescription Opioid Use

AbstractBackground and aimsOpioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD.MethodsThis is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit.ResultsThe 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models.ConclusionsWith comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD.ImplicationsFor patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.

scholarly journals Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center

2021 ◽  
Vol 12 (2) ◽  
pp. 13
Author(s):  
Melanie Berry ◽  
Amy Gustafson ◽  
Maya Wai ◽  
Alex J. Luli
Keyword(s):  
Medical Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Acceptance Rate ◽  
Demographic Information ◽  
Consult Service ◽  
Descriptive Data ◽  
Academic Medical ◽  
Patient Demographic Information

Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service.  Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.

scholarly journals The Impact of a Palliative Care Consult Service on the Functions of a Medical Ethics Committee (701)

2010 ◽  
Vol 39 (2) ◽  
pp. 421-422
Author(s):  
Teresa Albanese ◽  
Jessica Moeller ◽  
Steven Radwany ◽  
Summa Health SystemAkron ◽  
Jill Bradshaw ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Ethics ◽  
Ethics Committee ◽  
Consult Service ◽  
The Impact

The Value of a Brief Thought for the Day Reflection on an Academic Consult Service

2016 ◽  
Vol 34 (9) ◽  
pp. 869-873 ◽  
Author(s):  
Thomas O’Neil ◽  
Patricia Lyndale ◽  
Kathryn Szakatis ◽  
Tom Fitzgerald
Keyword(s):  
Physical Activity ◽  
Palliative Medicine ◽  
Reflective Writing ◽  
Workplace Stress ◽  
Consult Service ◽  
Team Members ◽  
Qualitative And Quantitative ◽  
Perceived Utility ◽  
Religious Writing ◽  
Competing Demands

Background: Work in hospice and palliative medicine can be stressful. A variety of methods have been used to mitigate workplace stress including mindfulness mediation, reflective writing, and physical activity. An intervention implemented at our institution is a “Thought for the Day,” a short reflection on a piece of poetry, music, or religious writing. Although this practice may be commonplace in the field of hospice and palliative medicine, no literature has been published about its perceived utility by team members with various competing demands on their time. Objective: This study’s objective was to obtain a better understanding about the perception and utility of a Thought for the Day held by clinicians rounding on an academic palliative medicine consult service. Methods: A survey, containing qualitative and quantitative elements was sent to faculty, staff, and learners who participated in a Thought for the Day over the 18 months between March 2013 and October 2014. Twenty-eight responses were returned and analyzed. Results: Most participants (23 of the 28) felt that the Thought for the Day was an important use of their time on the academic consult service. Differences were seen by gender and team role. Additionally, it was reported that the Thought for the Day improved the participants’ perception of teamwork. Conclusion: The use of a Thought for the Day reflection may be beneficial and constructive even for a busy academic consult service.

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