Pharmacist interventions in an outpatient pain clinic at a Veterans Affairs Medical Center

Abstract

Purpose: Clinical pharmacist practitioners (CPPs) ensure safe and evidence-based pharmacotherapy practices. However, there is little information to date characterizing the impact of pain CPP interventions on patient outcomes within a CPP-managed outpatient chronic and postoperative pain clinic. The primary objective of this study was to classify and quantify the number of pain CPP interventions in the outpatient pain clinic at the West Palm Beach Veteran Affairs Medical Center (WPB VAMC). The secondary objective assessed general patient outcomes associated with pain pharmacotherapy management by a CPP. Summary: A retrospective chart review of pain CPP encounters was utilized to identify interventions over a 12-month period. A total of 805 pain management encounters with a total of 1993 interventions were recorded by pain CPPs during that time. Descriptive statistics and sample size calculations were used to summarize and evaluate results. Overall, 55% of interventions were pharmacological, 45% were nonpharmacological interventions, and 5% were referrals to other specialty providers. For the secondary objective (n = 107), patients in the pain clinic on opioid therapy experienced an average oral morphine equivalent daily dose (MEDD) reduction of 21 mg without any identified suicide or overdose events and achieved on average 45% of their SMART goals by their last visit. In patients with baseline pain, enjoyment of life, and general activity (PEG) scores (n = 69), there were 43% of patients with improved PEG scores at their last visit in which 14% (10/69) experienced a clinically meaningful improvement in PEG scores. Conclusion: Pain CPPs demonstrated a reduction in overall MEDDs safely while following the biopsychosocial approach to pain management by incorporating and referring for nonpharmacological interventions as well as completing opioid risk mitigation. Additional studies are needed to better characterize pain CPP impact on patient outcomes.