Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom.
Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom; Primary Integrated Community Solutions, Unit H4 Ash Tree Court, Nottingham Business Park, Nottingham NG8 6PY, United Kingdom.
Res Social Adm Pharm. 2022 Mar;18(3):2352-2366. doi: 10.1016/j.sapharm.2020.11.014. Epub 2020 Nov 24.
Opioid optimisation is a global issue in Chronic Non-malignant Pain (CNMP) management.
This systematic review aims to assess the effectiveness of interventions delivered by pharmacists in outpatient clinical settings, community pharmacies and primary care services in optimising opioid therapy for people with CNMP and to explore stakeholders' opinions about role of pharmacists in optimising opioid therapy.
We conducted searches in PubMed, CINAHL, Psych Info, EMBASE, ISI Web of Science and Conference Proceedings and International Pharmaceutical Abstracts. All studies where pharmacists in outpatient clinical settings, community pharmacies and patient care services helped in optimisation of opioids in the treatment of CNMP as individuals or part of a team were included. Authors followed the 27-item PRISMA guidelines and the review was registered in PROSPERO. All authors were involved in screening and selection of studies and included studies between January 1990-June 2020. Studies not published in English language and participants with cancer pain were excluded. All the included studies were descriptively synthesized.
Fourteen studies were included in the final data synthesis of this review and the total number of participants in all studies was 1175. Interventions by pharmacists were successful in decreasing opioid dose in 4 studies and improved patient opioid safety in 5 studies. Stakeholders considered that the role of pharmacists in optimisation of opioid therapy for people with CNMP can be promising and should be further developed.
This systematic review gives an overview of pharmacist intervention feasibility, stakeholders' opinions and possible benefits on opioid optimisation in people with CNMP in outpatient clinical settings, community pharmacies and primary care settings. However, further research is warranted, which can guide the development of new policies and guidelines for the utilisation of pharmacists to promote opioid safety in people using prescription opioids for CNMP management.
阿片类药物优化是慢性非恶性疼痛（CNMP）管理中的全球性问题。
本系统评价旨在评估药剂师在门诊临床环境、社区药房和初级保健服务中为 CNMP 患者优化阿片类药物治疗的干预措施的有效性，并探讨利益相关者对药剂师在优化阿片类药物治疗中的作用的看法。
我们在 PubMed、CINAHL、Psych Info、EMBASE、ISI Web of Science 和会议论文集以及国际药学文摘中进行了搜索。所有将药剂师作为个体或团队成员纳入门诊临床环境、社区药房和患者护理服务中，以帮助优化阿片类药物治疗 CNMP 的研究均被纳入。作者遵循了 27 项 PRISMA 指南，并在 PROSPERO 中进行了注册。所有作者都参与了研究的筛选和选择，并纳入了 1990 年 1 月至 2020 年 6 月期间发表的研究。未以英文发表的研究和有癌症疼痛的参与者被排除在外。所有纳入的研究均进行了描述性综合。
本综述的最终数据综合纳入了 14 项研究，所有研究的参与者总数为 1175 人。药剂师的干预措施在 4 项研究中成功降低了阿片类药物剂量，在 5 项研究中提高了患者的阿片类药物安全性。利益相关者认为，药剂师在优化 CNMP 患者阿片类药物治疗中的作用具有很大的潜力，应该进一步发展。
本系统评价概述了药剂师干预的可行性、利益相关者对门诊临床环境、社区药房和初级保健环境中 CNMP 患者阿片类药物优化的看法以及可能的益处。然而，需要进一步的研究，以指导制定利用药剂师促进处方阿片类药物治疗 CNMP 管理中阿片类药物安全性的新政策和指南。
