Tip of the Week: Routine Opioid Outcome Monitoring in Community Pharmacy Presents Opportunities

There is nothing wrong with being opportunistic. In fact, being opportunistic is usually a good thing for your patients and your practice. Being opportunistic in pharmacy means helping to address unmet needs and solving problems. We often think about value-added services as those that address chronic conditions or in regard to public health initiatives, such as providing immunizations. Much has been said and done to address the problem of opioid misuse. This has included pharmacy, but there are still many patients that can be helped now and in the future, and the opportunity to do so presents itself pretty much on a daily basis.

In a study published in Research in Social and Administrative Pharmacy, researchers piloted the implementation of a software-facilitated Routine Opioid Outcomes Monitoring (ROOM) program. The study authors remind readers of the ongoing problem of opioid misuse, and its comorbidities such as depression, its concurrent problems such as misuse of alcohol and benzodiazepines, and common adverse effects and quality of life issues such as constipation. Although there are lengthy clinical assessment tools for opioid prescribers, methods to facilitate time-efficient and routine use of opioid use monitoring are much less available.

The study authors used the theory of planned behavior to guide the design of the clinical intervention that would increase pharmacists’ capability, motivation, and opportunity to identify and respond to opioid-related problems, and called it ROOM given its ability to be adapted into everyday practice. It employed the use of software that prompted pharmacists to offer the ROOM tool to patients receiving a second or subsequent opioid prescription.

The ROOM tool consists of just a few questions and screens to risk stratify patients. Pharmacists were trained on its use and for familiarity with the software. There were 64 pharmacists from 23 pharmacies who completed ROOM with 152 patients. Following implementation, pharmacists reported being more confident in identifying patient risks and responding to patients who may be developing dependence and suffering from depression, having more knowledge about naloxone, and greater comfort intervening when concerned about a prescription for opioids. Patients who completed the ROOM tool at the pharmacy were emailed an evaluation survey and reported that it was easy to complete and provided useful information.

Although there are many tools to assist with monitoring, care administered prospectively by pharmacists can add great value, elevate practice, and improve outcomes. The idea behind this intervention was not merely to curb abuse but to also assist patients who are on opioid therapy and mitigate adverse effects and shape behaviors that can mitigate concomitant deleterious events associated with opioid use. Rather than being the “opioid police,” pharmacists came off as compassionate and caring while their efficacy in treating patients improved.

This is an example of making simple interventions a more routine part of practice. Pharmacy managers can instill that sort of culture in the pharmacy, and pharmacy personnel can demonstrate empathy and knowledge that will make for more satisfied patients who are living better lives as a result.

Additional information about Value-Added Services as a Component of Enhancing Pharmacists’ Roles in Public Health and Managing Technology that Supports the Medication Use Process can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

REFERENCE

Nielsen S, Picco L, Kowalski M, Sanfilippo P, et al. Routine opioid monitoring in community pharmacy: Outcomes from an open-label single-arm implementation-effectiveness pilot study. Res Social Adm Pharm. 2020;16(12):1694-1701.

ABOUT THE AUTHOR

Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at Touro University California College of Pharmacy.