Assessing the impact of clinical pharmacists on naloxone coprescribing in the primary care setting.

Abstract

Opioid use and overdose are epidemic in the United States. While there is concern regarding the abuse of illegal opioids, overdose is also strongly associated with prescription opioids. The Centers for Disease Control and Prevention supports coprescribing of naloxone with opioids; however, a review of naloxone prescriptions recorded within a primary care group indicated limited use of the reversal agent. Through the collaboration of pharmacy and information services personnel, a report was created to identify all patients receiving chronic opioid therapy. To assess the risk of overdose, a validated risk scoring method was used. If patients were determined to be at high risk for overdose, outreach by a clinical pharmacist was conducted to educate them on the benefits of naloxone. For patients agreeable to receiving naloxone, prescriptions were entered into the electronic health record for primary care provider (PCP) verification. Contact was made following order verification to ensure patient understanding of proper naloxone use and naloxone accessibility. Prior to the project (ie, in calendar year 2016), only 5 prescriptions for naloxone had been prescribed within the medical group. During the naloxone coprescribing initiative, 230 patients were identified by clinical pharmacists as being at elevated risk for opioid overdose. Of these, 86 (37%) were deemed ineligible for naloxone. Out of the 144 patients determined to be eligible, 63 (44%) were agreeable to receiving naloxone. Further review determined that 7 additional patients were agreeable after a follow-up conversation with their PCP. Of the patients that agreed to receive naloxone, 48 (76%) confirmed that they had picked up naloxone from their pharmacy. The naloxone coprescribing initiative was an innovative project that focused on an epidemic that affects communities across the United States. This program embraced the strengths of multiple departments for the good of the patient, in keeping with the idea of team-based care. The pharmacy-driven approach highlighted the importance of having pharmacists within an ambulatory care setting and allowed high-level pharmacist practice without adding to the workload of other members of the healthcare team.