Pharmacist ambulatory pain services for a chronic non-cancer pain clinic: a descriptive study

Background

Patients presenting to specialist pain clinics are often prescribed complex and high-risk analgesic regimens. In this setting, pharmacists can help identify at risk patients and provide valuable clinical input to improve patient outcomes.

Aim

To evaluate the role of a clinical pharmacist in improving the triage, assessment and management of patients presenting to ambulatory pain clinics.

Method

This descriptive study enrolled patients from two chronic noncancer pain clinics from July to December 2021. A new clinical pharmacist service was devised, which operated as telehealth one day per week. The pharmacist was responsible for accepting referrals, triaging based on clinic criteria and updating them with prescription risk factors, in line with SafeScript's traffic light system. Pharmacist clinical services included completion of medication histories, drug dose interventions and patient education. This project received departmental ethical approval from the Eastern Health Office of Research and Ethics prior to commencement (Approval No: QA21-068).

Results

The pharmacist assessed 253 patients and identified prescription risk factors for 68 patients; of which 11 (16%) had received opioids from ≥4 prescribers, 10 (15%) were issued a monitored prescription from ≥4 pharmacies, seven (10%) were on high-risk drug combinations, 25 (37%) had an Oral Morphine Equivalent Daily Dose (OMEDD) of 50–100 mg, and 26 (38%) with OMEDD >100 mg. The pharmacist completed 67 medication histories and provided 22 accepted drug intervention recommendations to clinic physicians, including seven recommendations for dose adjustments, six to cease a medicine and nine to start a new medicine.

Conclusion

The pharmacist incorporated SafeScript in the clinics' triage processes and provided valuable clinical interventions complementing the care provided by the pain physicians and the allied health staff.