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Impact of Community-based Pharmacist Intervention on Initial Opioid Prescribing

Kinney, Olivia
http://orcid.org/0000-0002-3063-6523
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1602153052809053

Abstract Details

2020, MS, University of Cincinnati, Pharmacy: Pharmaceutical Sciences.
Background: When starting opioid therapy, guidelines recommend immediate-release products rather than extended-release to reduce overdose risk and likelihood of continuation. Guidelines also state more than seven days supply of an opioid is rarely needed. In response to the United States’ opioid epidemic, the Pharmacy Quality Alliance (PQA) developed and endorsed an Opioid Core Measure Set including Initial Opioid Prescription (IOP) quality measures that assess the percent of individuals with one or more IOPs for long duration, at high dosage, or for a long-acting or extended release opioid product. Objectives: The study objectives are to 1) quantify and describe the characteristics of initial opioid prescriptions dispensed during the measurement period and 2) measure the impact of an initial opioid prescription intervention on Pharmacy Quality Alliance Initial Opioid Prescribing measure performance, compared to current standard practice in community pharmacy. Methods: This project is a stepped wedge research study to evaluate an interventional alert within a large community chain. Thirty-four states with participating pharmacies were randomized to one of three intervention start dates. Data were analyzed for a 28-week time period from February to November 2019 using descriptive statistics, independent t-tests, chi-squared tests, a linear regression model, and a logistic mixed effect regression model. The alert was developed and presented to pharmacists during initial prescription review to facilitate prescriber consultation, appropriate dispensing, and better quality of care for patients prior to prescription pick up. Documentation was required in the alert before resolution. Pharmacists completed interventions by validating the patient met the quality measure criteria and then addressing the gap in therapy through prescriber or patient consultation. Results: When controlling for time period and other store-level variables, a 1% decrease (p-value 0.004) in the PQA IOP long duration (quantity) rate and a 0.4% (p-value 0.603) decrease in the long-acting or extended-release (product) rate was observed in the intervention group compared to control. Over 400,000 initial opioid prescriptions were dispensed during the measurement period with a mean age of 54 years (60% female). Nearly 43% of IOPs were for a hydrocodone-containing product and over 56% were covered by a commercial insurance plan. Conclusion: Opioid naive patients prescribed a clinically inappropriate initial opioid prescription can be identified using prescription fill history and PQA IOP quality measure criteria. A pharmacist intervention within workflow can significantly reduce the percentage of clinically inappropriate initial opioid prescriptions dispensed.
Pamela Heaton, Ph.D. (Committee Chair)
Andrea Brookhart, PharmD BCACP (Committee Member)
Ana Hincapie, Ph.D. (Committee Member)
64 p.
Pharmaceuticals
opioid; community pharmacy; initial opioid prescription; opioid naive; pharmacy

Recommended Citations

Citations

  • Kinney, O. (2020). Impact of Community-based Pharmacist Intervention on Initial Opioid Prescribing [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1602153052809053

    APA Style (7th edition)

  • Kinney, Olivia. Impact of Community-based Pharmacist Intervention on Initial Opioid Prescribing. 2020. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1602153052809053.

    MLA Style (8th edition)

  • Kinney, Olivia. "Impact of Community-based Pharmacist Intervention on Initial Opioid Prescribing." Master's thesis, University of Cincinnati, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1602153052809053

    Chicago Manual of Style (17th edition)

ucin1602153052809053
178
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This open access ETD is published by University of Cincinnati and OhioLINK.