Ehrhard Kim, Colvard Michelle, Brabson Jennifer
Clinical Pharmacy Specialist, VA Tennessee Valley Healthcare System, Nashville, Tennessee.
Ment Health Clin. 2022 Aug 23;12(4):219-224. doi: 10.9740/mhc.2022.08.219. eCollection 2022 Aug.
At a Veterans Affairs Medical Center (VAMC), a clinical pharmacist practitioner (CPP) was added to an inpatient addiction triage team in August 2019 to provide education and recommendations regarding medications for alcohol use disorder (MAUD) and opioid use disorder (MOUD). Before the addition of the CPP, missed opportunities for MAUD and MOUD education and prescribing prior to discharge on non-psychiatric units were observed.
This was a single-center, single-site, retrospective, observational cohort study with a primary objective to compare initiation rates of MAUD/MOUD 12 months before and after the addition of the CPP to the addiction triage team. Secondary end points included 90-day medication possession ratio, 1- and 3-month emergency department visit rates, 1- and 3-month hospital readmission rates, and opioid education and naloxone distribution interventions for eligible patients with a diagnosis of opioid use disorder.
Both statistically and clinically significant improvements in MAUD/MOUD initiation rates were found in the CPP intervention group compared with the historical control group (26.3% vs 4%, < .0001). Although secondary end points within this review were not found to be statistically significant, improvements were seen in the CPP intervention group compared with the historical control group related to medication possession ratio, and emergency department and hospital readmission rates.
This study highlights the potential utility of a CPP to an inpatient addiction triage team to improve MAUD/MOUD prescribing rates in appropriate patients prior to discharge. Overall, the introduction of a CPP to an inpatient addiction triage team was feasible, well received by interprofessional team members, and required limited additional resources.
2019年8月，一家退伍军人事务医疗中心（VAMC）在住院成瘾分诊团队中增加了一名临床药剂师从业者（CPP），以提供关于酒精使用障碍药物（MAUD）和阿片类药物使用障碍药物（MOUD）的教育和建议。在增加CPP之前，观察到在非精神科病房出院前，MAUD和MOUD教育及处方存在错失机会的情况。
这是一项单中心、单地点、回顾性观察队列研究，主要目的是比较在成瘾分诊团队中增加CPP前后12个月MAUD/MOUD的起始率。次要终点包括90天药物持有率、1个月和3个月的急诊科就诊率、1个月和3个月的住院再入院率，以及对符合阿片类药物使用障碍诊断的患者进行阿片类药物教育和纳洛酮分发干预。
与历史对照组相比，CPP干预组在MAUD/MOUD起始率方面在统计学和临床上均有显著改善（26.3%对4%，P<0.0001）。尽管本综述中的次要终点未发现有统计学意义，但与历史对照组相比，CPP干预组在药物持有率、急诊科和住院再入院率方面有改善。
本研究强调了CPP对住院成瘾分诊团队的潜在效用，可提高合适患者出院前MAUD/MOUD的处方率。总体而言，在住院成瘾分诊团队中引入CPP是可行的，受到跨专业团队成员的欢迎，且所需额外资源有限。
