A Pharmacist-Led Program to Taper Opioid Use at Kaiser Permanente Northwest: Rationale, Design, and Evaluation.
A Pharmacist-Led Program to Taper Opioid Use at Kaiser Permanente Northwest: Rationale, Design, and Evaluation.
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DOI：
10.7812/tpp/19.216
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发表时间：
2020-01-01
影响因子：
--
通讯作者：
Smith, David H
中科院分区：
文献类型：
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作者：
Kuntz, Jennifer L;Schneider, Jennifer L;Smith, David H
简介：初级保健医生 (PCP) 担心阿片类药物使用的不良反应和不良结果，但可能会发现由于缺乏疼痛管理培训或限制患者咨询的时间限制，阿片类药物逐渐减少很困难。 2010 年，Kaiser Permanente Northwest 实施了一项由药剂师主导的阿片类药物逐渐减少计划——疼痛管理支持团队现场资源 (STORM)——以解决阿片类药物的高使用率、减轻 PCP 的工作量需求并改善患者的治疗结果。 目的：描述这一由药剂师主导的独特计划的基本原理、结构和实施方式，该计划与 PCP 合作并提供个性化护理，帮助患者减少阿片类药物的使用，以及通过逐渐减少研究促进降低阿片类药物用量，该研究检查该计划的有效性、成本效益和实施情况。结果：STORM 计划包括一名疼痛医学医师、一名社会工作者或护士以及接受过专门临床和沟通培训的药剂师。该计划具有双重作用：1) 为 PCP 提供有关疼痛管理和阿片类药物使用的教育，2) 为临床医生和患者提供阿片类药物逐渐减少和疼痛管理方面的支持。计划培训结束后，PCP 可以与患者讨论逐渐减量的必要性并参考该计划。计划药剂师提供一系列服务，包括阿片类药物逐渐减量计划、非阿片类药物疼痛管理建议以及为患者提供减量支持外展服务。讨论：STORM 计划提供个性化护理，帮助阿片类药物逐渐减量患者，同时减轻 PCP 的负担。结论：STORM 计划可能是对医疗保健系统和寻求解决患者阿片类药物逐渐减量需求的方案的有价值的补充。
INTRODUCTION: Primary care practitioners (PCPs) are concerned about adverse effects and poor outcomes of opioid use but may find opioid tapering difficult because of a lack of pain management training or time constraints limiting patient counseling. In 2010, Kaiser Permanente Northwest implemented a pharmacist-led opioid tapering program-Support Team Onsite Resource for Management of Pain (STORM)-to address high rates of opioid use, alleviate PCPs' workload demands, and improve patient outcomes.OBJECTIVE: To describe the rationale, structure, and delivery of this unique pharmacist-led program, which partners with PCPs and provides individualized care to help patients reduce opioid use, and the Facilitating Lower Opioid Amounts through Tapering study, which examines the program's effectiveness, cost-effectiveness, and implementation.RESULTS: The STORM program includes a pain medicine physician, a social worker or nurse, and pharmacists who have received specialized clinical and communications training. The program has a 2-fold role: 1) to provide PCP education about pain management and opioid use and 2) to offer clinician and patient support with opioid tapering and pain management. After program training, PCPs are equipped to discuss the need for tapering with a patient and to refer to the program. Program pharmacists provide a range of services, including opioid taper plans, nonopioid pain management recommendations, and taper-support outreach to patients.DISCUSSION: The STORM program provides individualized care to assist patients with opioid tapering while reducing the burden on PCPs.CONCLUSION: The STORM program may be a valuable addition to health care systems and settings seeking options to address their patients' opioid tapering needs.