Mailloux Lindsay M, Haas Matthew T, Larew Janel M, DeJongh Beth M
Mental Health Clinical Pharmacy Specialist, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.
Associate Professor of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, Wisconsin.
Ment Health Clin. 2021 Jan 8;11(1):35-39. doi: 10.9740/mhc.2021.01.035. eCollection 2021 Jan.
Physician-pharmacist collaborative practice models (PPCPM) decrease barriers and increase access to medications for opioid use disorder (MOUD) but are not routine in practice. The purpose of this quality improvement initiative is to develop and implement a PPCPM for management of patients on MOUD with buprenorphine/naloxone to minimize provider burden, expand access to treatment, and enhance overall patient care.
A PPCPM for management of patients on MOUD with buprenorphine/naloxone was piloted in an outpatient substance use disorder clinic. Approximately 4 hours per week were dedicated to physician-pharmacist collaborative medical appointments for a 5-month trial period. The pharmacist met with the patient first and then staffed the case with the collaborating psychiatrist. Descriptive data from PPCPM appointments was collected and compared to data from psychiatrist-only appointments.
Twenty-five patients were seen over 44 appointments with an estimated 33 hours of psychiatrist time saved. Average initial and end buprenorphine doses, urine drug screen (UDS) results, and mental health (MH) medication interventions were similar between patients seen in PPCPM appointments compared with those seen in psychiatrist-only appointments. Collection of UDS, identification and management of MOUD adherence issues, other service referrals, and medication reconciliation intervention were more frequent in PPCPM appointments.
Implementation of a PPCPM allowed for provision of a similar level of care regarding MOUD and MH-related medication management while saving psychiatrist time. Other enhancements to patient care provided through pharmacist intervention included more frequent identification and management of MOUD adherence issues, referral for other services, and medication reconciliation interventions.
医师 - 药师协作实践模式（PPCPM）减少了障碍，并增加了阿片类药物使用障碍（MOUD）患者获得药物治疗的机会，但在实际操作中并不常见。这项质量改进计划的目的是开发并实施一种PPCPM，用于管理使用丁丙诺啡/纳洛酮进行MOUD治疗的患者，以减轻医疗服务提供者的负担，扩大治疗机会，并提高整体患者护理水平。
在一家门诊物质使用障碍诊所对一种用于管理使用丁丙诺啡/纳洛酮进行MOUD治疗患者的PPCPM进行了试点。在为期5个月的试验期内，每周大约投入4小时用于医师 - 药师协作医疗预约。药剂师先与患者会面，然后与协作的精神科医生共同处理病例。收集了PPCPM预约的描述性数据，并与仅由精神科医生进行预约的数据进行了比较。
在44次预约中诊治了25名患者，估计节省了精神科医生33小时的时间。与仅由精神科医生进行预约诊治的患者相比，PPCPM预约诊治的患者在丁丙诺啡初始和最终剂量、尿液药物筛查（UDS）结果以及心理健康（MH）药物干预方面相似。在PPCPM预约中，UDS的收集、MOUD依从性问题的识别和管理、其他服务转诊以及用药核对干预更为频繁。
实施PPCPM在MOUD和与MH相关的药物管理方面能够提供相似水平的护理，同时节省了精神科医生的时间。通过药剂师干预为患者护理带来的其他改进包括更频繁地识别和管理MOUD依从性问题、转诊至其他服务以及用药核对干预。
