Implementation of a pharmacist care manager model to expand availability of medications for opioid use disorder
Implementation of a pharmacist care manager model to expand availability of medications for opioid use disorder
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DOI：
10.1093/ajhp/zxaa405
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发表时间：
2021-02-15
影响因子：
2.7
通讯作者：
Krebs, Erin E.
中科院分区：
文献类型：
--
作者：
DeRonne, Beth M.;Wong, Kara R.;Krebs, Erin E.
目的。阿片类药物处方的增加，通常用于慢性疼痛治疗，导致整个美国阿片类药物使用障碍(OUD)的患病率增加，包括在退伍军人事务部(VA)医疗系统内。退伍军人特别容易受到阿片类药物相关伤害的影响，但为OUD开药的比例一直很低。OUD护理经理模式的使用增加了获得治疗的机会。在这篇文章中，我们提供了在明尼阿波利斯退伍军人事务卫生保健系统中实施的用于OUD治疗的药物的临床药剂师护理经理(CPCM)模式的概述。针对OUD的药物治疗的CPCM模式被确定为一种护理模式，该模式将解决患者和设施障碍对有效的OUD治疗的影响。药剂师在计划的制定和实施中是不可或缺的，并充当主要的护理提供者。对该计划的中期评估表明，有OUD的患者接受阿片使用障碍(Moud)药物治疗的比例有所增加，该计划的使用导致在625次就诊期间治疗了109名独特的患者。主要的计划实施促进者包括设施领导层，将增加Moud的使用作为优先领域，确定医生冠军，以及在退伍军人管理局系统内成功扩展临床药学专家实践的历史。实施障碍包括与提供商接洽、患者身份识别和计划支持相关的因素。CPCM提供Moud的模式扩大了药师在丁丙诺啡管理中的作用。增加接受MOUD治疗的患者数量的需要导致了CPCM模式的实施。该计划被有效地实施到实践中，并扩大了Moud的可用性，使患者能够在多种护理环境中获得治疗。
Purpose. The rise in opioid prescribing, often for chronic pain management, resulted in an increased prevalence of opioid use disorder (OUD) throughout the United States, including within the Veterans Affairs (VA) healthcare system. The veteran population has been especially vulnerable to opioid-related harms, but rates of prescribing medications for OUD have been low. Use of care manager models for OUD have increased access to treatment. In this article we provide an overview of a clinical pharmacist care manager (CPCM) model for medications for OUD treatment implemented within the Minneapolis Veterans Affairs Health Care System.Summary. A CPCM model for medications for OUD was identified as a care model that would address patient and facility barriers to effective OUD treatment. Pharmacists were integral in program development and implementation and served as the main care providers. An interim evaluation of the program established that the proportion of patients with OUD receiving medications for opioid use disorder (MOUD) had increased, with use of the program resulting in treatment of 109 unique patients during 625 visits. Key program implementation facilitators included the facility leadership establishing increased use of MOUD as a priority area, identification of a physician champion, and a history of successful expansion of clinical pharmacy specialist practice within the VA system. Implementation barriers included factors related to provider engagement, patient identification, and program support. The CPCM model of provision of MOUD expanded the pharmacist role in buprenorphine management.Conclusion. The need to increase the number of patients receiving MOUD led to the implementation of a CPCM model. The program was effectively implemented into practice and expanded the availability of MOUD, which allowed patients to access treatment in multiple care settings.