School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
Br J Clin Pharmacol. 2021 Dec;87(12):4504-4533. doi: 10.1111/bcp.14915. Epub 2021 Jun 13.
To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.
本研究旨在对初级保健环境中药师在阿片类药物管理中的活动进行范围综述，包括药师主导或参与的活动，以及药师作为更广泛的多学科团队成员的活动，并对这些活动、护理模式和环境以及报告的结果进行整理。检索了 MEDLINE、EMBASE、国际药学文摘、CINAHL、SCOPUS 和 Web of Science 等文献数据库。符合条件的研究为具有定量评估并以英文发表的研究。参与者为任何疼痛类别或阿片类药物使用障碍的患者以及医疗保健提供者。不包括源自医院或涉及供应功能的研究。两名研究人员对文献进行筛选，并对结果进行数据图表绘制。该范围综述中包含的 51 项研究发生在初级保健环境中，分为四个类别：全科医生或初级保健诊所、医疗机构、社区药房和外展服务。研究主要针对慢性非癌性疼痛中的阿片类药物使用。其他适应症为阿片类药物使用障碍、癌症和牙痛。药师的活动旨在降低风险、对患者和提供者进行教育以及采取更广泛的战略方法。患者相关的结果包括减少阿片类药物用量、改善功能和症状管理、增加对服务和药物辅助治疗的获取以及参与风险缓解策略。还证明了提供者行为的改变。该综述确定了在初级保健环境中工作的药师可以做出重大贡献，以最大限度地减少阿片类药物的危害。通过更大的协作和协调（如阿片类药物管理）实施单独实施的策略有可能进一步降低不良临床结果。
