In this episode of Pharmacy Focus, a podcast from Pharmacy Times, an expert panel of guests discusses the implementation of Project Lifeline, an initiative integrating SBIRT (screening, brief intervention, and referral to treatment) into pharmacy workflows to address opioid and substance use disorder. The episode features Sarah Roszak, DrPH, MPH, senior vice president of health and wellness strategy and policy for the National Association of Chain Drug Stores (NACDS); Jessica Northcott-Brillati, MSW, LCSW, PMH-C, program manager at the University of Pittsburgh School of Pharmacy’s Program Evaluation and Research Unit; and Vanessa Campbell, PharmD, BCGP, director of clinical pharmacy at UPMC Health Plan.
During the episode, the experts discuss how the program evolved from a rural pilot to a scalable, technology-driven model in urban and suburban settings. They highlight key findings, including high patient engagement and the importance of pharmacist-patient trust in promoting screenings. The conversation also covers expansion efforts into 5 states and the role of health plans in sustaining the program, emphasizing how pharmacies serve as vital access points for substance use screening and intervention.
Key Takeaways
1. Pharmacists as Frontline Screeners: Project Lifeline successfully integrated SBIRT into pharmacies, demonstrating that pharmacists can effectively screen and refer patients for opioid use disorder treatment.
2. Technology and Patient Engagement: Implementing digital screening tools improved efficiency and privacy, leading to a nearly 70% patient participation rate.
3. Scaling Nationwide: Based on success in Pennsylvania, the initiative is expanding to 5 states, leveraging health plan partnerships to ensure long-term sustainability.
Luke Halpern: Hello everyone, and welcome back to another episode of Pharmacy Focus, a podcast from Pharmacy Times. My name is Luke Halpern, an assistant editor with Pharmacy Times. On today's episode, we're going to be talking about Project Lifeline, which is a new study that was released. I’m here with 3 expert panelists, and we are excited to talk about what these results of the study means for clinical practice and for community pharmacists across the country. Without further ado, we can get started. Sarah, do you want to start with introductions? And then we can go to Jess and then Vanessa.
Sara Roszak: Hi, I'm Sarah Roszak. I am senior vice president of health and wellness strategy and policy for the National Association of Chain Drug Stores (NACDS). Separately, I'm president of the NACDS Foundation, which is a separate but affiliated 501c3 charitable organization that funds groundbreaking research. We also support educational initiatives and philanthropic endeavors.
Jess Northcott-Brillati: Hey, my name is Jess Northcott-Brillati. I'm a program manager at the University of Pittsburgh School of Pharmacy’s Program Evaluation and Research Unit. It's a bit of a mouthful, so I'll refer to as Pitt PERU through this podcast. And I am also the care coordinator for the Project Lifeline initiative.
Vanessa Campbell: Hi, I'm Vanessa Campbell. I'm one of our directors of clinical pharmacy at UPMC Health Plan. I was one of the payers involved in the study for Project Lifeline. And at the Health Plan, I helped to oversee all of our pharmacy care management, quality, and some of our providers shared saving strategies as it relates to pharmacy.
Halpern: Excellent. Thank you, all 3 of you, for your introductions. Amazing, we can get right into the questions. We're going to start with Jess on this first question. Just to give our audience a brief overview of what the Project Lifeline intervention was, could you just provide this brief overview and what are some of the latest results? And additionally, how did the results of phase 2 of Project Lifeline build on phase 1?
Northcott-Brillati: Sure. The Project Lifeline intervention is integrating SBIRT—screening, brief intervention, and referral to treatment—protocols and workflows into the pharmacy setting. For SBIRT, it's an evidence based public health approach to identify and address risky substance use. What that looked like in a pharmacy space is, if someone is prescribed an opioid medication, they would come into the pharmacy, their medication would get flagged at the insurance verification process, so that the pharmacy staff knew that when that patient came to pick up their medication, that they would be offered a screening measure. It was 3 questions just to assess the risk level, and the patient completed it independently on a tablet. From there, if there was risky substance use or alcohol use identified from those questions, they were given a full screen. Once they completed that, the tablet in our Project Lifeline app would calculate the outcome of the screen so it would tell the pharmacist if an intervention was warranted, and what that recommended intervention would be. If it was a brief intervention, so providing patient education, or if it was a referral to treatment, where they would contact the care coordinator that was part of the project, so myself, and I would work with that individual to get them access to recovery resources from the pharmacy.
How that built from phase 1, kind of the epic of Project Lifeline, is it started in Blair County, which is more central rural Pennsylvania. At that point, we were just seeing if it was feasible with the Blair County project. They were doing paper screens. We didn't have an app at the time, and there was a certified recovery specialist that would rotate amongst all the pharmacies that would sit there and offer support to individuals that might need it. What we took away from that project was that it's easier if there's an app, because it was really cumbersome for the pharmacist to score this screening tool, and also for the patient to feel more comfortable completing the tool; to independently answer the questions on the app offered them more privacy. That's what we brought to the Allegheny project, was that application. We also found that having someone rotate amongst all the pharmacies was really tough, especially if you have someone at one pharmacy and someone at the other pharmacy at the same time, someone can't be in 2 places at once. So, we had a built-in core care coordinator—myself—that could address any patient needs. We also partnered with UPMC Health Plan to help ensure the sustainability of the services so that patients can make sure they have access to the care.
Some of the key results from Project Lifeline Allegheny County was, we focused mostly on engagement, and we saw a lot of engagement within the urban setting. It wasn't as much, I would say, in the rural, just because it was 8 pharmacies in a rural setting versus 17; we were able to touch more patients in the first one. However, we can attribute that to pharmacies serving more patients in rural areas, whereas in an urban area, 17 pharmacies in Pittsburgh is just a drop in the bucket, essentially. However, we also want to give the context to Project Lifeline. We started implementation in 2020 through 2021, which was when pharmacies were onboarding the intervention. Also, we want to give the pharmacy some credit that the COVID-19 vaccine was being rolled out at that point, so the pharmacies had a short bandwidth, and it was also tougher for patients to want to engage with the screen, because being in a pharmacy during that time could be scary. We're always trying to increase access to substance use treatment and recovery resources for all populations. This [intervention] proved that pharmacies could be an access point to reach folks that aren't accessed in traditional settings.
Halpern: Fantastic. That was a perfect overview of the entire intervention. We're going to move to Sarah for our next question. Along the lines of discussing SBIRT, how and why is broader implementation of SBIRT important to advancing public health?
Roszak: The beauty of this project is that it's all about identifying patients and people who present themselves at the pharmacy and are flagged or were identified as potentially benefiting from additional screening and then bringing them into the health care system, providing referrals, offering wraparound services and supporting them with care that they may need. So, making SBIRT for opioid use disorder more broadly available and a common practice can really amplify public health impact. Like Jess mentioned, we've seen really strong results in 2 prior pilots in the Pennsylvania area, and now we have the opportunity to bring that intervention to communities across several states, actually across 5 states. We're really trying to leverage that pharmacies are uniquely positioned trying to engage patients on risk reduction strategies and address opioid use disorder together in their communities. We're looking to implement the intervention more broadly, trying to reduce stigma and help more people. I think one of the most important pieces of the project is that while this current effort is about opioid use disorder, the SBIRT framework or model could be applied to many other health conditions. What we're really trying to do here is build a model or a framework that brings together pharmacies, health plans, and other community partners to find a solution to this really important public health issue. There are a lot of different public health issues that could benefit from this type of type of intervention.
The NACDS Foundation is really focused on funding research that can be proven feasible, but also sustainable. Research that can live beyond the confines of a grant and could one day be implemented broadly in communities without grant support and live on beyond the project. I think the evolution of this project has been really powerful, because all along the way, the project team has published their findings, which allows other people to see what they're doing and how it's impacted those specific communities, and then other researchers and people who are implementing programs and practice can take those learnings and use them in their own communities. I'm excited to see what this next phase brings with much broader outreach. I just want to say that we couldn't do this work without the great researchers, partners, pharmacies, payers, and others who have participated with us along the way. The 2 on the phone, those groups have been with us since the very, very beginning, and now we're getting to kind of branch out to additional folks in different areas, too, to join us along the way. But it's been a really exciting journey that, at this point, has been ongoing for several years since it started with a small rural pilot, and has really blossomed since then.
Halpern: Yeah, absolutely. Shifting over to more of a health plans perspective, Vanessa, could you describe a little bit how the work of Project Lifeline is important from their perspective of health plans?
Campbell: Absolutely. I think there's many reasons why this project was so important to us, but I think one of the biggest things was the ability to help increase access to screening tools and provide community awareness, as both Jess and Sarah already stated, and really to provide support to such a much-needed topic. Being able to build enhanced collaboration with our community pharmacy partners is huge, just because it's really helped to bridge the gap in identifying members who may be at risk of substance use disorders, and also building additional connections for that, coordination of care and providing opportunities for referrals back into health plan programs. This really allows for comprehensive care for the member and their needs, by bridging that gap and bringing all of us together to really, truly, look at what's best for the member.
Halpern: One of the major points of the results from this project is that patient engagement was very high; nearly 70% of eligible patients completed their screening. Jess, how can community pharmacies effectively integrate SBIRT into practice? And what strategies from Project Lifeline phase 2 proved most successful in engaging patients?
Northcott-Brillati: Yeah, this was probably one of the most exciting parts of the project. The biggest thing that our team took from an implementation perspective was meeting the pharmacist and the patients where they were at. Every pharmacy is different, and so we really work to make sure that the protocols, whether the pharmacy had a drive-thru, whether it in a grocery store, whether they had a private room or not, all of the different factors that it really fit into their setting and what worked for their staff. One of the big strategies that we used was being consistent with offering the SBIRT screens, because then it creates this expectation of: the patient's going to be asked. Oftentimes when folks, and I'm guilty of it too, I want to go into the pharmacy, pick up my medication and leave, and it's a very fast process. Sometimes having that additional step of “stop, we might have some questions and get to know you better,” it just is different. It's creating this culture of the patients thinking that this is a place where we can talk about it. Oftentimes, what we found in this project was a patient, they might not agree to take the screen the first time, but maybe on the second or third time, when more trust and rapport is established, they're more inclined to take the screen. We also came from a perspective of, this isn't punitive, this is something where we're just trying to offer resources and support. It helped develop that trust with a pharmacist. I had a couple of pharmacists share with me that it reminded them of why they got into the work: building relationships with the community members, offering their knowledge and some expertise to help support folks, and making sure that there is safer prescription use along the way. We also coach the pharmacy staff on strategies like non-judgmental approaches to talking about substance use. This was something that, a lot of folks, they had the baseline skills; they know how to talk about it, but because there's so much stigma that still exists with substance use, they were very nervous to engage with patients. We worked with them; they had the skills, which was exciting to see. They knew what they were talking about. It was helping build their confidence and comfort levels. It really developed this culture. Even a couple of patients that I had worked with from the care coordination perspective, it was nice for them to know that this is a place where, if they need help, they can come and get support. The pharmacist reciprocated that sentiment as well.
Halpern: That was a great explanation of one of the major parts of that study. Overall, I mean, the SBIRT implementations seem to be very feasible across this population in Project Lifeline phase 2. This question is going to be for Sarah: given the feasibility demonstrated in this study, what could be done to help expand SBIRT implementation across more community pharmacies nationwide, to help more patients and support better outcomes?
Roszak: The effort to expand this project is ongoing, and this work is being done now. We have benefited from the technical expertise and support from the Pitt PERU team to look through advancing impact of SBIRT across different communities. They've done a comprehensive landscape assessment to determine potential key states and areas where there could be greatest impact and most need. For the project we're currently focused on recruiting pharmacy and health plan partners in 5 states: Tennessee, Louisiana, Ohio, North Carolina, and Kentucky. The beauty of NACDS Foundation projects is that we want all partners, any partners, who can meet the recruitment and research criteria to participate. That's really any and all community pharmacies in those states that have an interest and are able to participate in this type of research are welcome to reach out to us and join us in this effort. It's an opportunity that's open to all, and we'd love to be really inclusive here and get folks to join us. There could be opportunities in the future to expand to additional states, but this is where we're starting first. I would say, too, engagement from health plan partners is extremely important, and the work that UPMC Health Plan has done with this project has been critical in leading the way and helping to shape for this project what that type of collaboration and partnership looks like, and how we can look to build on that and include additional payer partners in other states. That's a really key piece to be able to have this type of work live beyond the confines of the grant and continue forward after we conclude the project. We're just really, really focused on how we can achieve long term impact to improve health and promote access to care. So, any and all who want to join us, we are actively recruiting in in the states where we're hoping to work. We're looking at Tennessee, Louisiana, Ohio, North Carolina, and Kentucky, and we'd love for folks to join us.
Halpern: Amazing. Yeah, folks listening should definitely, if you're interested, do that. This is kind of a follow up question to that; how were those 5 states chosen for potential expansion? Was there any background into that decision?
Northcott-Brillati: Yeah, I can speak more to that. We did an analysis, essentially, that looked at a variety of factors. For example, prevalence of substance use disorders, overdose rates in the state, social deprivation index scores. We basically created a prioritization index of where is the greatest need. Where can we bring this? Especially because it is such a great access point for folks and if we can bring it to where there's a great need, maybe there's more access across the board.
Halpern: Moving back towards the perspective of health plans in how this work can be implemented across the country, Vanessa, what is the most important part and aspect from the perspective of health plans in scaling the work and implementing it broadly to improve patient health and outcomes related to opioid use disorder?
Campbell: Sure. I think the fact that there are so many quality-related measures around opioid and substance use ,and really just looking at everything holistically from a public health perspective, I think there's a strong need for every stakeholder to continue this work, in order to learn and grow from these efforts in order to lead to other collaborative best practices. Specifically, my team at UPMC Health Plan, our pharmacist team, we do a lot of telephonic- or telehealth-related outreach to provide support to our members. But I really think and what this pilot really shows is the relationship building with the community pharmacies is really important in order to capture those point-of-sale, face to face encounters with members that you may never have been able to reach otherwise. As Jess and Sarah both talked about earlier, I really think that the success of the engagement in this pilot really comes from these community pharmacists that already have these built in relationships with their patients, and these patients trust them. They see them regularly. Patients feel comfortable with them from seeing them each month when they pick up their prescriptions. Really integrating these discussions into their workflow is one way that they were able to really engage them to complete the screening. I just think that this just makes sure that we're casting a wider net of support around these members, trying to make sure that we're doing everything that we can as this health care ecosystem to truly impact the member-related outcomes in this area. I know that they always say it truly takes a village, and it really does, in order for us to truly impact care, which I think that this pilot really is a great example of.
Halpern: That's a great quote to end on, because it does seem like you guys took this village and made it your own with the 2 phases of Project Lifeline, especially the second phase. The work is very important. Thank you all for that amazing overview of Project Lifeline and implications for community pharmacy and for opioid use disorder. We still have some time left, so if you all want to give a little conclusion spiel, we could start with Sarah, and you can just say anything that you might have on your mind, where you could be reached, and any final thoughts about Project Lifeline.
Roszak: The NACDS foundation is focused on cultivating innovation and care. One of the ways that we do that is through funding innovative research studies. We're excited to look at studies that that start as small pilots and can build from there and then move on to become nationwide larger studies that all along the way, produce published research that then communities can take and look at and replicate where possible. I think project Lifeline is a really good example of how to go about doing that. Many times when we're looking to fund research, we're looking at, what are community pharmacy researchers doing in the field that's really interesting that could be lifted up and potentially applied in different ways. Not just community pharmacy research, but public health research and health services research broadly, and how could some of those learnings be applied to the community pharmacy setting. There had been a lot of research on SBIRT broadly, and I think this study has really helped us home in on how pharmacies and health plans can be a really great part of the solution to this public health issue.
Northcott-Brillati: I would say, to add on to what Sarah is saying, we are working on a national implementation to continue this work. If anyone is interested in partnering or even just learning more talking about this project, please reach out to the NACDS Foundation or the University of Pittsburgh School of Pharmacy. More than happy to talk through it more and to see how we can roll up our sleeves and work together.
Campbell: From a health plan standpoint, I personally have been so honored to represent UPMC Health Plan and work with these wonderful ladies and their foundations in order to really help break down silos and barriers, to help our members, the communities we live in, and just helping to support overall public health. It's been a really great experience.
Halpern: Fantastic. Well, this is a lovely way to end our discussion today. Sarah, Jess, and Vanessa, thank you all so much for taking this time out of your busy schedules to talk about this important issue. I really appreciate it. All your insights were amazing, and I'm sure our listening audience is going to get a lot out of this talk today. Thank you all again for your work in getting this discussion set up. Thank you all for listening to this episode of Pharmacy Focus, a Pharmacy Times podcast. We'll see you in the next episode.
