Norman Jessica L, Kroehl Miranda E, Lam Huong Mindy, Lewis Carmen L, Mitchell Chelsea N, O'Bryant Cindy L, Trinkley Katy E
University of Colorado School of Pharmacy, Aurora, CO.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO.
Am J Health Syst Pharm. 2017 Aug 15;74(16):1229-1235. doi: 10.2146/ajhp160294.
A pharmacist-managed chronic pain clinic (PMCPC) in a primary care setting is described.
As primary care providers (PCPs) may be unprepared or lack time to manage high-risk patients receiving opioids for chronic nonmalignant pain, alternative models of care are needed. The University of Colorado PMCPC is integrated into an internal medicine outpatient clinic. The PMCPC is staffed by 1 clinical pharmacist, with pharmacy students and residents also performing clinic duties. The pharmacy team reviews health records to determine eligibility for PMCPC services and documents referral requests in the electronic health record (EHR); on PCP acceptance of a referral, the pharmacy team assumes primary responsibility for the patient's pain management under a collaborative practice agreement. Using a collaborative drug therapy management (CDTM) protocol, the pharmacy team conducts patient assessments, including an assessment for signs of aberrant drug-taking behaviors; provides initial and ongoing counseling and education; and makes recommendations to the PCP for opioid dosage adjustments and regimen additions and discontinuations. Experience at the clinic to date indicates that the PMCPC model is feasible and accepted by PCPs and patients.
A PMCPC based in a primary care setting was established to improve the care of patients with chronic nonmalignant pain who are prescribed opioid therapy for a period of 3 months or longer. Clinic patients are referred to the clinic through the EHR and managed by a pharmacist under a CDTM protocol.
描述在初级保健机构中由药剂师管理的慢性疼痛诊所（PMCPC）。
由于初级保健提供者（PCP）可能没有准备好或缺乏时间来管理接受阿片类药物治疗慢性非恶性疼痛的高风险患者，因此需要替代的护理模式。科罗拉多大学的PMCPC整合到内科门诊诊所中。PMCPC配备1名临床药剂师，药学专业学生和住院医师也承担诊所职责。药房团队审查健康记录以确定是否符合PMCPC服务资格，并在电子健康记录（EHR）中记录转诊请求；在PCP接受转诊后，药房团队根据合作医疗协议承担患者疼痛管理的主要责任。药房团队使用合作药物治疗管理（CDTM）方案进行患者评估，包括对异常用药行为迹象的评估；提供初始和持续的咨询与教育；并向PCP建议调整阿片类药物剂量以及增减和停用治疗方案。该诊所目前的经验表明，PMCPC模式是可行的，并且得到了PCP和患者的认可。
在初级保健机构中建立了PMCPC，以改善接受阿片类药物治疗3个月或更长时间的慢性非恶性疼痛患者的护理。诊所患者通过EHR转诊至该诊所，并由药剂师根据CDTM方案进行管理。
