8 pharmacy track pharmacists working with local coalitions and pdm ps
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Transcript of 8 pharmacy track pharmacists working with local coalitions and pdm ps
Pharmacy Track:Pharmacists Working with
Local Coalitions and PDMPsPresenters:
• Nicole O'Kane, PharmD, Clinical Director, Acumentra Health
• Kristina Clark, CPS-II, Executive Director, Coffee County (TN) Anti-Drug Coalition
• Christina Merino, CPS-II, Prevention Coordinator, Coffee County (TN) Anti-Drug Coalition
Moderator: Michael H. Ghobrial, PharmD, JD, Associate Director, Health Policy, American Pharmacists Association, and Member, Rx Summit National Advisory Board
Disclosures
• Nicole O'Kane, PharmD; Kristina Clark, CPS-II; Christina Merino, CPS-II; and Michael H. Ghobrial, PharmD, JD, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.
Disclosures
• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
• The following planners/managers have the following to disclose:– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center– Carla Saunders – Speaker’s bureau: Abbott Nutrition
Learning Objectives
1. Identify ways pharmacists may contribute to the reduction of Rx drug abuse, misuse and diversion.
2. Explain the critical role for pharmacists in collaborative and outreach efforts to reduce Rx drug abuse, misuse and diversion.
3. Describe how pharmacists may utilize the PDMP to screen for potential safety concerns.
4. Specify recommendations for optimizing pharmacists’ use of the PDMP to improve patient care.
Pharmacist’s Role in Addressing Addiction and Diversion: PDMP as
an Important Clinical Tool
Nicole O’Kane, PharmDClinical Director
Acumentra Health
Disclosure Statement
Nicole O’Kane, PharmD, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
Learning Objectives
1. Describe how pharmacists may utilize the PDMP to screen for potential safety concerns.
2. Specify recommendations for optimizing pharmacists’ use of the PDMP to improve patient care.
Outline
1. Introduction
2. The expanding role of pharmacists
3. Practitioner use of the Oregon Prescription Drug Monitoring Program (PDMP)
4. Oregon initiatives
Acumentra Health
• Portland-based nonprofit consulting firm, dedicated to improving quality, safety, and effectiveness of health care
• Collaborate with practitioners in all care settings, and with purchasers, community-based organizations, professional associations, policy makers, and consumers
www.acumentra.org
Use of Prescription Monitoring Programs to Improve Patient Care and Outcomes
• 5-year grant (2012‒2017) to study effectiveness of the Oregon Prescription Drug Monitoring Program as a clinical decision tool for prescribers of controlled substance medications
Supported by the National Institutes of Health, National Institute for Drug Abuse through Grant # 1 R01 DA031208-01A1, and by the National Center for Research Resources and the National Center for Advancing Translational Sciences, through grant UL1RR024140
Study Aims
AIM 1:Determine the prevalence and characteristics of PDMP users and non-users
AIM 2:Determine how providers use PDMP data; formulate recommendations for clinical guidelines
AIM 3: Determine whether PDMP use improves patient outcomes and reduces apparent diversion/abuse
Pharmacists in Health Care
• Community pharmacies
• Hospital systems
• Primary care clinics
• Specialty care
• Home infusion
• Long-term care settings
• Health plans
• Public heath policy
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Pharmacists in Health Care
Community pharmacists
Clinical pharmacists
The expanding role of pharmacists
Pharmacist Responsibility
The dispensing pharmacist is in the same position as the practitioner who issued the prescription and must exercise professional judgment to determine whether a prescription for a controlled substance was issued for a legitimate reason.
DEA regulations (21 CFR §1306.04)
http://deachronicles.quarles.com/2013/08/a-pharmacists-obligation-corresponding-responsibility-and-red-flags-of-diversion/
Pharmacist Responsibility
Assessment of each patient and prescription:
• Legitimate medical need
• Possible intent to divert or misuse controlled substances
• Possible addiction that requires appropriate referral and treatment
Pharmacist Survey Results
• PDMP perceived as a valuable screening tool
• Half report receiving training in identifying prescription drug diversion, abuse, or addiction
• Interest in screening and discussing misuse
Cobaugh, D. J., et al. Am J Health Syst Pharm, 2014;71(18), 1539-1554.Gavaza, P., et al. Res Social Adm Pharm, 2014;10(2), 448-458.Hagemeier, N. E., et al. Subst Use Misuse, 2013;48(9), 761-768.Cochran G., et al. J Pharm Pract. 2014 Feb 13 [epub ahead of print]
Pharmacist Survey Results
• Potential safety concerns prompt additional actions
– Contact prescriber
– Contact other pharmacies
– Specific patient counseling or referral
– Deny prescription
Pharmacist Use of PDMP
• New corporate policies include additional requirements and documentation
– Prevent diversion or abuse
– Concerns about access for legitimate pain need
• Barriers to workflow integration
• Lack evidence on best practices
http://www.nabp.net/system/rich/rich_files/rich_files/000/000/209/original/consensus-document.pdf
Oregon PDMP
This program seeks to promote public health and welfare and help improve patient care. The information helps healthcare providers and pharmacists to better manage patients' prescriptions to improve quality of care. It also supports the appropriate use of prescription drugs.
http://www.orpdmp.com
Oregon PDMP
• Program began data upload June 2011
• Oregon National Governor’s Association Task Force on Prescription Drug Abuse 2012
• PDMP enhancements include allowing delegate users starting January 2014
http://www.orpdmp.com
Cumulative Number of System Accounts by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.
New System Accounts by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.
Users Submitting Queries by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.
Number of System Queries by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.
Oregon Initiatives
• Medically supervised lay person naloxone rescue program
• Coordinating efforts across systems
– Methadone removed from state formulary
– Community take-back days
– Oregon Pain Guidance website:
www.southernoregonopioidmanagement.org
http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
A Socio-Ecological Model
Organizationalorganizations,
social institutions
Individualknowledge,
attitudes, skill
Interpersonalfamily, friends, social networks
Communitycounty, town, neighborhood
Society & public policynational, state, and local
laws and regulations
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“To stem the tide of the unintended consequences of the promotion of drug use it will be necessary for health systems, clinicians, academics, epidemiologists, patients, pharmacists, communities, law enforcement, and pain specialists to work together. “
- Drug Overdose Deaths, Hospitalizations, Abuse and Dependency among Oregonians Report 2014
http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
Pharmacists Working with Local
Coalitions and PDMPs
Kristina Clark, Executive Director
&
Christina Merino, Prevention Coordinator
Coffee County Anti-Drug Coalition, Tennessee
Disclosure Statements
• Kristina Clark, CPS II, Executive Director, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods or services.
• Christina Merino, CPS II, Prevention Coordinator, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods or services.
Learning Objectives
1. Identify ways pharmacists may contribute to
the reduction of Rx drug abuse, misuse and
diversion.
2. Explain the critical role for pharmacists in
collaborative and outreach efforts to reduce
Rx drug abuse, misuse and diversion.
Contributing
Factors:
Community Based
A. Ease of Access
1. Home
2. School
B. Perception of Harm
1. of Parents
2. of Youth
Access Harm Abuse
Capacity & Planning
Medical Professional Forum
• Key Stakeholders
• Implements
• Time Constraints
Communication Plan
• Accountability for
Deliverables
• Strategic Targeting
- Pharmacies
- Doctors
- Dentists
• Action PlanningFocus Groups
Plan
TeamAction!
Community Level Change
Education
Written Prescription
ConsultationPrescription
Obtained
Behavior Change
Implementation
Evaluation
Dropped 30 day
prescription drug use by
approximately 25% in 6th,
8th, 10th, and 12th grades.*
Increased by 20% the number of youth with clear family rules concerning alcohol, tobacco, and other drugs.*
Increased by 18% the number of 10th and 12th
graders reporting that it is harder to get prescription drugs.*
*2009 compared to 2012 Student Survey Data
Evaluation
Increased from 0% to 24% the number of community members who report locking up their medications.*
Decreased by 24% the number of community members reporting keeping prescription medications.*
Increased community members tracking medications from 0% to 21%.*
Decreased by 50% the students reporting sharing prescription drugs (2009 compared to 2012 Student Survey Data).
*2009 compared to 2012 Drug Take Back Survey Data
Questions
Thank you for your time and attention.
Kristina Clark
Christina Merino
Coffee County Anti-Drug Coalition
(931) 570-4484 – Office
(931) 570-2361 - Fax
Pharmacy Track:Pharmacists Working with
Local Coalitions and PDMPsPresenters:
• Nicole O'Kane, PharmD, Clinical Director, Acumentra Health
• Kristina Clark, CPS-II, Executive Director, Coffee County (TN) Anti-Drug Coalition
• Christina Merino, CPS-II, Prevention Coordinator, Coffee County (TN) Anti-Drug Coalition
Moderator: Michael H. Ghobrial, PharmD, JD, Associate Director, Health Policy, American Pharmacists Association, and Member, Rx Summit National Advisory Board