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R&E Update: Spotlight on the Best Resident Project Award Winner

21 Sep 2020 4:04 PM | Anonymous

By: Jackie A. Harris, PharmD, BCPS; Executive Director, MSHP Research & Education Foundation

Dr. Joseph Walter, a PGY2 Ambulatory Care resident at CoxHealth this past residency year, was awarded the Best Resident Project during the Virtual KCHP/MSHP Spring Meeting for his project entitled “Impact of Pharmacist-led Education on Providers’ Prescribing Rates and Perceptions of Naloxone in High-Risk Opioid Patients”. With the number of naloxone prescriptions increasing by 106% from 2017 to 2018, one would expect to see that same correlation in our high-risk patient populations. Unfortunately, that is not the case with only one naloxone prescription for every 69 high-dose opioid prescription.

This prospective, observational study was conducted to evaluate the impact of pharmacist-led education had on providers’ naloxone prescription rates. In addition, the study also assessed providers’ perceptions of naloxone in high-risk patients after pharmacist-led education. Provider perceptions of naloxone in high-risk patients was assessed before and after education utilizing a Likert scale. Providers across three primary care clinics were sent an online link to pharmacist-led education on how to identify high-risk opioid patients and how to order naloxone for those patients. The

percentage of naloxone prescriptions for high-risk opioid patients were evaluated six months before education and six months after education to evaluate the effectiveness of the pharmacist-led education.

High-risk patients were defined as being 18 years or older with chronic pain receiving > 50 morphine milligram equivalent (MME). Additionally those patients 65 years or older receiving < 50 MME/day with either kidney, liver, and/or respiratory disease, concurrent use of benzodiazepines, and a history of substance use disorder were also considered high-risk.

The naloxone prescription rate in these three primary care clinics was 8% before pharmacist education and then 6% post education. Note this data was derived from 3 months. Provider perceptions of naloxone in high-risk opioid patients was assessed by the following survey questions:

  1. How likely are you to identify patients at high-risk for overdose on opioids for chronic pain?
  2. How likely are you to prescribe naloxone for high-risk patients on opioids for chronic pain?
  3. How likely are you to provide education to patients who may initially refuse a prescription for naloxone?
  4. How likely are you to incorporate a pharmacist into the patient care team for naloxone education?

Based upon the survey results, pharmacist-led education did improve their ability to identify patients at a high-risk for overdose on opioids for chronic pain, increased the likelihood of physicians prescribing naloxone alongside opioids in patients with chronic pain that are high-risk, and increased the ability of the providers to provide education on naloxone.

This study highlighted the need for pharmacist education on naloxone prescribing for high-risk opioid patients and showed the impact of that education. The pharmacists will continue to work alongside those physicians at the primary care clinics and make recommendations to prescribe naloxone in those high-risk opioid patients.

If you have any questions about Dr. Walter’s project, please contact him at joseph_walter@my.uri.edu.

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