Impact of Pharmacist Previsit Input to Providers on Chronic Opioid Prescribing Safety

Article Figures & Data

Table 1.

Patient Demographics

Characteristics	Patients (n = 45)
Age (years), mean (SD)	57 (13)
Female sex	22 (49)
Race/ethnicity
White	40 (89)
Hispanic	3 (7)
Other	4 (9)
Native American	1 (2)
Pain indication^*
Unspecified joint pain	30 (67)
Neuropathy	17 (38)
Unspecified back pain	15 (33)
Unspecified muscle pain	11 (24)
Unspecified pain	11 (24)
Osteoarthritis	10 (22)
Spinal disease or pain	9 (20)
Unspecified neck pain	7 (16)
Fibromyalgia	3 (7)
Migraine	2 (4)
Rheumatoid arthritis	2 (4)
Other	8 (18)
Comorbidities^*
Tobacco use	28 (62)
Anxiety	27 (60)
Depression	25 (56)
Insomnia	20 (44)
Alcohol use	18 (42)
Migraines	9 (20)
History of illicit drug use	5 (11)
Bipolar	3 (7)
Other psychiatric condition	2 (4)

Data are n (%) unless otherwise indicated.
↵* Characteristics are not mutually exclusive. Patients may have multiple documented indications and comorbidities.
SD, standard deviation.

Table 2.

Morphine Milligram Equivalents per Day and Pain Scores

Outcomes	Before Intervention (n = 45)	After Intervention (n = 45)	P Value
MMEs/day
Based on prescription directions	151 (110)	125 (114)	<.001
Based on number of pills prescribed per month	135 (100)	116 (106)	<.001
Pain scores^*	5.3 (2.6)	5.5 (2.5)	.783

Data are mean (standard deviation) unless otherwise indicated.
↵* Only patients with data available before and after the intervention were included in analysis of this outcome (n = 27).
MME, morphine milligram equivalent.

Table 3.

Secondary Outcomes

Outcomes	Before Intervention (n = 45)	After Intervention (n = 45)	P Value
Patients concurrently taking high-risk medications
Benzodiazepines	21 (47)	14 (31)	.008
Hypnotics	10 (22)	7 (16)	.083
Muscle relaxants	8 (18)	10 (22)	.157
Nonopioid analgesics prescribed, mean (SD)	2.1 (1.3)	2.4 (1.4)	.002
Opioid analgesics prescribed, mean (SD)	1.6 (0.6)	1.5 (0.7)	.219
Offered outpatient naloxone prescription	6 (13)	22 (49)	.009
Current urine drug screen^*	15 (33)	27 (60)	<.001
Current review of the state's PDMP^{^†}	12 (27)	26 (58)	<.001
Referral to pain specialist	17 (38)	21 (47)	.046
Referral to physical therapy	33 (73)	34 (76)	.317
Patients prescribed a bowel regimen	6 (13)	22 (49)	<.001

Data are n (%) unless otherwise indicated.
↵* “Current” is defined as completed within the preceding 12 months.
↵† “Current” is defined as completed and documented within the preceding 3 months.
PDMP, prescription drug monitoring program; SD, standard deviation.

Table 4.

Pharmacist and Provider Effort and Time

Outcomes	Value
Pharmacist
Total reviews provided, n	80
Reviews per patient	1.8 (0.9)
Minutes required for review	33 (19)
Pharmacist recommendations
Total recommendations provided, n	301
Total recommendations implemented, n (% of total recommendations provided)	114 (38)
Provided per patient	6.3 (1.5)
Implemented per patient	2.5 (1.3)
Provider
Total appointments, n	118
Appointments per patient	2.6 (1.3)

Appendix 1.

Morphine Milligram Equivalents Conversion

Appendix 2.

Select Recommendations Given and Implemented

Select Recommendations	Given to Provider, n (% of patients)	Implemented, n (% of specific recommendation)
Initiate/change non-opioid analgesic regimen	45 (100)	22 (49)
Consider opioid taper	43 (96)	22 (51)
Refer to pain specialist	42 (93)	5 (12)
Offer outpatient naloxone prescription	37 (82)	20 (54)
Review state's PDMP	35 (78)	15 (43)
Obtain urine drug screen	31 (69)	16 (52)
Taper/discontinue concurrent high-risk medications	20 (44)	8 (40)