The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Intervention
2.2. Study Participants
2.3. Baseline and Outcome Measures
2.4. Statistical Method Used
3. Results
3.1. Participant Demographics
3.2. Primary and Secondary Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Available online: https://icd.who.int/en (accessed on 26 February 2020).
- Health Canada. Available online: https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019.html (accessed on 26 February 2020).
- Reitsma, M.; Tranmer, J.E.; Buchanan, D.M.; van den Kerkhof, E.G. The epidemiology of chronic pain in Canadian men and women between 1994 and 2007: Longitudinal results of the national population health survey. Pan Res. Manag. 2012, 17, 166–172. [Google Scholar] [CrossRef] [PubMed]
- Schopflocher, D.; Taenzer, P.; Jovey, R. The prevalence of chronic pain in Canada. Pain Res. Manag. 2011, 16, 445–450. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Steingrimsdottir, O.A.; Landmark, T.; Macfarlane, G.J.; Nielsen, C.S. Defining chronic pain in epidemiological studies: A systematic review and meta-analysis. Pain 2017, 158, 2092–2107. [Google Scholar] [CrossRef]
- Hogan, M.E.; Taddio, A.; Katz, J.; Shah, V.; Krahn, M. Incremental health care costs for chronic pain in Ontario, Canada: A population-based matched cohort study of adolescents and adults using administrative data. Pain 2016, 157, 1626–1633. [Google Scholar] [CrossRef] [PubMed]
- Turner, B.J.; Liang, Y.; Simmonds, M.J.; Rodriguez, N.; Bobadilla, R.; Yin, Z. Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients. J. Gen. Intern. Med. 2018, 33, 668–677. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Geneen, L.J.; Moore, R.A.; Clarke, C.; Martin, D.; Colvin, L.A.; Smith, B.H. Physical activity, and exercise for chronic pain in adults: An overview of Cochrane Reviews. Cochrane Database Syst. Rev. 2017, 4, CD011279. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ball, E.; Nur, S.M.S.E.; Franklin, G.; Rogozinska, E. Does mindfulness meditation improve chronic pain? A systematic review. Curr. Opin. Obstet. Gynecol. 2017, 29, 359–366. [Google Scholar] [CrossRef] [PubMed]
- Ontario College of Pharmacists. Available online: https://www.ocpinfo.com/regulations-standards/practice-policies-guidelines/opioid-policy/ (accessed on 26 February 2020).
- Government of Canada. Available online: https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2017-summary.html#n3 (accessed on 26 February 2020).
- Lakha, S.F.; Ballantyne, P.; Badr, H.; Agboatwala, M.; Mailis, A.; Pennefather, P. Perspective of pain clinicians in three global cities on local barriers to providing care for chronic non-cancer pain patients. Pain Res. Manag. 2019, 3091309. [Google Scholar] [CrossRef]
- Kang, I.; Urick, B.; Vohra, R.; Ives, T.J. Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study. Res. Soc. Adm. Pharm. 2019, 15, 1027–1031. [Google Scholar] [CrossRef]
- Government of Canada. Available online: https://health-infobase.canada.ca/substance-related-harms/opioids (accessed on 26 February 2020).
- Canadian Pharmacists Association. Available online: https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Pharmacy%20Services%20Report%201.pdf (accessed on 26 February 2020).
- Comprehensive Alcoholism Rehabilitation Program (CARP). Available online: https://www.carp.ca/2013/05/17/carp-prescription-drug-poll-report/ (accessed on 26 February 2020).
- Patel, T.; Chang, F.; Mohammed, H.T.; Raman-Wims, L.; Jurcic, J.; Sproule, B. Knowledge, perceptions and attitudes toward chronic pain and its management: A cross-sectional survey of frontline pharmacists in Ontario, Canada. PLoS ONE 2016, 11, e0157151. [Google Scholar] [CrossRef]
- Keller, S.; Bann, C.; Dodd, S.L.; Schein, J.; Mendoza, T.; Cleeland, C.S. Validity of the brief pain inventory for use in documenting the outcomes of patients with non-cancer pain. Clin. J. Pain 2004, 20, 309–318. [Google Scholar] [CrossRef]
- Hays, R.D.; Sherbourne, C.D.; Mazel, R.M. The rand 36-item health survey 1.0. Health Econ. 1993, 2, 217–227. [Google Scholar] [CrossRef] [PubMed]
- Fredheim, O.M.S.; Borchgrevink, P.C.; Saltnes, T.; Kaasa, S. Validation and comparison of the health-related quality-of-life Instruments EORTC QLQ-C30 and SF-36 in assessment of patients with chronic nonmalignant pain. J. Pain Symptom. Manag. 2007, 34, 657–665. [Google Scholar] [CrossRef] [PubMed]
- Wittink, H.; Turk, D.C.; Carr, D.B.; Sukiennik, A.; Rogers, W. Comparison of the redundancy, reliability, and responsiveness to change among SF-36, Oswestry Disability Index, and Multidimensional Pain Inventory. Clin. J. Pain 2004, 20, 133–142. [Google Scholar] [CrossRef]
- Farrar, J.T.; Young, J.P.; LaMoreaux, L.; Werth, J.L.; Poole, R.M. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001, 94, 149–158. [Google Scholar] [CrossRef]
- Mishriky, J.; Stupans, I.; Chan, V. Expanding the role of Australian pharmacists in community pharmacies in chronic pain management—A narrative review. Pharm Pract 2019, 17, 1410. [Google Scholar] [CrossRef] [Green Version]
- Perrot, S.; Cittee, J.; Louis, P.; Quentin, B.; Robert, C.; Milon, J.-Y.; Bismut, H.; Baumelou, A. Self-medication in pain management: The state of the art of pharmacists’ role for optimal over-the-counter analgesic use. Eur. J. Pain 2019, 17, 1747–1762. [Google Scholar] [CrossRef]
- Liu, S.; Gnjidic, D.; Nguyen, J.; Penm, J. Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review. Br. J. Clin. Pharmacol. 2019, 86, 210–243. [Google Scholar] [CrossRef]
- Stafford, R.; Thomas, J.; Payakachat, N.; Diemer, T.; Lang, M.; Kordsmeier, B.; Curran, G. Using an array of implementation strategies to improve success rates of pharmacist-initiated medication therapy management services in community pharmacies. Res. Social. Adm. Pharm. 2017, 13, 938–946. [Google Scholar] [CrossRef]
- Smith, B.H.; Penny, K.I.; Purves, A.M.; Wilson, B.; Grimshaw, J.; Chambers, W.A.; Smith, W.C. The chronic pain grade questionnaire: Validation and reliability in postal research. Pain 1997, 71, 141–147. [Google Scholar] [CrossRef]
- Hadi, M.A.; Alldred, D.P.; Briggs, M.; Munyombwe, T.; Closs, S.J. Effectiveness of pharmacist-led medication review in chronic pain management. Systematic review and meta-analysis. Clin. J. Pain 2014, 30, 1006–1014. [Google Scholar] [CrossRef] [PubMed]
- Phelan, M.; Foster, N.E.; Thomas, E.; Hay, E.M.; Blenkinsopp, A. Pharmacist-led medication review for knee pain in older adults: Content, process, and outcomes. Int. J. Pharm. Pract. 2008, 16, 347–355. [Google Scholar] [CrossRef]
- Murphy, L.; Chang, F.; Dattani, S.; Sproule, B. A pharmacist framework for implementation of the Canadian guideline for opioids for chronic non–cancer pain. Can. Pharm. J. 2019, 152, 35–44. [Google Scholar] [CrossRef] [PubMed]
- Zgierska, A.E.; Vidaver, R.M.; Smith, P.; Ales, M.W.; Nisbet, K.; Boss, D.; Tuan, W.-J.; Hahn, D.L. Enhancing system–wide implementation of opioid prescribing guidelines in primary care: Protocol for a stepped–wedge quality improvement project. BMC Health Serv. Res. 2018, 18, 415. [Google Scholar] [CrossRef]
- Busse, J.W.; Craigie, S.; Juurlink, D.N.; Buckley, N.; Wang, L.; Couban, R.J. Guideline for opioid therapy and chronic non–cancer pain. CMAJ 2017, 189, E659–E666. [Google Scholar] [CrossRef] [Green Version]
- Wayne, P.M.; Buring, J.E.; Eisenberg, D.M.; Osypiuk, K.; Gow, B.J.; Davis, R.B.; Witt, C.M.; Reinhold, T. Cost–effectiveness of a team–based integrative medicine approach to the treatment of back pain. J. Altern. Complement Med. 2019, 25, S138–S146. [Google Scholar] [CrossRef] [Green Version]
- Chisholm–Burns, M.A.; Kim-Lee, J.; Spivey, C.A.; Slack, M.; Herrier, R.N.; Hall–Lipsy, E. US pharmacist’s effect as team members on patient care: Systematic review and meta–analyses. Med. Care 2010, 48, 923–933. [Google Scholar] [CrossRef]
- Morgado, M.P.; Morgado, S.R.; Mendes, L.C.; Pereira, L.J.; Castelo–Branco, M. Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta–analysis. Am. J. Health–Syst. Pharm. 2011, 68, 241–253. [Google Scholar] [CrossRef]
- Ma, A.; Chen, D.M.; Chau, F.M.; Saberi, P. Improving adherence and clinical outcomes through an HIV pharmacist’s interventions. AIDS Care 2010, 22, 1189–1194. [Google Scholar] [CrossRef]
- Bauters, T.G.; Devulder, J.; Robays, H. Clinical pharmacy in a multidisciplinary team for chronic pain in adults. Acta Clin. Belg. 2008, 63, 247–250. [Google Scholar] [CrossRef]
- Ravn–Nielsen, L.V.; Duckert, M. –L.; Lund, M.L.; Henriksen, J.P.; Nielsen, M.L.; Eriksen, C.S.; Buck, T.C.; Pottegard, A; Hansen, M.R.; Hallas, J. Effect of an in–hospital multifaceted clinical pharmacist intervention on the risk of readmission. JAMA Int. Med. 2018, 178, 375–382. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mitra, F.; Woolley, T. Perceived patient benefits from using prescription opioids and other therapies to manage persistent pain. J. Opioid. Mang. 2019, 16, 5–14. [Google Scholar] [CrossRef]
- Diasso, P.D.K.; Birke, H.; Nielson, S.D.; Main, K.A.; Hojsted, J.; Sjogren, P.; Kurita, G.P. The effects of long–term opioid treatment on the immune system in chronic non–cancer pain patients: A systematic review. Eur. J. Pain 2020, 24, 481–496. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Frequency (%) |
---|---|
Age (years) | |
Mean (SD) | 52.6 (15.2) |
Range | 26 to 84 |
Gender | |
Female | 16 (84.2%) |
Male | 3 (15.8%) |
Marital status | |
Married/In a Stable Relationship | 7 (36.8%) |
Single | 6 (31.6%) |
Widowed | 4 (21.1%) |
Divorced | 2 (10.5%) |
Education | |
Elementary School | 6 (35.3%) |
High School | 4 (23.5%) |
Technical/College/University | 5 (29.4%) |
Graduate/Professional Education | 2 (11.8%) |
Employment | |
Employed | 5 (27.8%) |
Unemployed | 5 (27.8%) |
Retired | 7 (36.8%) |
Disabled | 2 (10.5%) |
Income (after tax) | |
<$20,000 | 8 (47.1%) |
$20,000 to $80,000 | 8 (47.1%) |
>$80,000 | 1 (5.9%) |
Medication CoverageA | |
Ontario Drug Benefit (ODB) | 10 (52.6%) |
Private/Employment Drug Plan | 7 (36.8%) |
Out of Pocket | 7 (36.8%) |
Type of Pain | |
Nociceptive | 3 (15.8%) |
Neuropathic | 8 (42.1%) |
Mixed | 7 (36.8%) |
Unclear | 1 (5.3%) |
Main Causes of Pain | |
Arthritis | 4 (21.0%) |
Fibromyalgia | 3 (15.8%) |
Low back pain | 3 (15.8%) |
Osteoarthritis | 3 (15.8%) |
Slipped disc | 3 (15.8%) |
Compression fracture | 2 (10.5%) |
Headache | 2 (10.5%) |
Tendonitis | 2 (10.5%) |
Duration of Pain | |
<5 years | 3 (15.8%) |
5 to 10 years | 5 (26.3%) |
10 to 20 years | 4 (21.1%) |
>20 years | 7 (36.8%) |
Number of Current Pain-Related Medications | |
Mean (SD) | 4.2 (2.0) |
Range | 1 to 9 |
Current Pain-Related Medications | |
Antidepressants | 15 (78.9%) |
Over-the-Counter drugs | 12 (63.1%) |
Opioids | 11 (57.9%) |
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) | 9 (47.4%) |
Benzodiazepines | 8 (42.1%) |
Anticonvulsants | 7 (36.8%) |
Muscle relaxants | 3 (15.8%) |
Medical cannabis | 1 (5.3%) |
Minerals | 1 (5.3%) |
Presence of Mental Health Conditions | 12 (63.2%) |
Depression | 7 (36.8%) |
Anxiety | 4 (21.0%) |
Sleep disorders | 4 (21.0%) |
Schizophrenia | 1 (5.3%) |
Bipolar Disorder | 1 (5.3%) |
Post-Traumatic Stress Disorder (PTSD) | 1 (5.3%) |
Recommendation | Initial Visit | Physician Accepted Recommendation | Implemented by 3 Month Follow up |
---|---|---|---|
Recommended Change in Medication | 40 | 24 (60.0%) | 18 (45.0%) |
Starting a medication | 28 | 16 (57.1%) A | 11 (39.3%) |
Switching a medication | 3 | 3 (100.0%) A | 3 (100.0%) A |
Changing dosage | 9 | 5 (55.6%) | 4 (44.4%) |
Recommended Activity | 22 | DU | DU |
Self-management program | 7 | 1 (14.3%) | DU |
Exercise | 7 | 1 (14.3%) | DU |
Massage | 2 | 1 (50.0%) | DU |
Yoga | 2 | DU | DU |
Physiotherapy | 1 | DU | 1 (100.0%) |
Relaxation | 1 | DU | DU |
Meditation | 1 | DU | DU |
Acupuncture | 1 | 1 (100.0%) | DU |
Outcome Measure | Median BPI Score at Initial Visit | Median BPI Score at 2 Weeks (% Change from Baseline) | Median BPI Score at 3 Month Follow up (% Change from Baseline) | Median Difference (Initial Visit vs. 3 Month Follow up) (95% CI) | Change in BPI Scores (Initial Visit vs. 3 Month Follow up) |
---|---|---|---|---|---|
Pain intensity | |||||
Overall pain | 6.3 | 5.9 (6.2%) | 5.5 (12.0%) | −0.13 (−1.13, 0.50) | p = 0.65 |
Worst pain | 8 | 7.5 (6.2%) | 8.0 (0.0%) | 0 (−1.00, 1.00) | p = 0.69 |
Least pain | 4 | 4.0 (0.0%) | 4.0 (0.0%) | 0 (−1.00, 0.50) | p = 0.58 |
Average pain | 6 | 6.0 (0.0%) | 6.0 (0.0%) | −0.50 (−1.00, 0.50) | p = 0.27 |
Pain right now | 6 | 5.5 (8.3%) | 5.0 (16.7%) | 0 (−1.00, 1.00) | p = 0.83 |
Pain interference | |||||
Overall pain interference | 6.6 | 5.9 (10.8%) | 6.1 (7.6%) | −0.08 (−0.93, 0.60) | p = 0.79 |
General activity | 7 | 5.5 (21.4%) | 6.0 (14.3%) | −0.50 (−1.50, 0.50) | p = 0.52 |
Mood | 7 | 5.5 (21.4%) | 7.0 (0.0%) | 0 (−1.00, 1.00) | p = 0.97 |
Walking ability | 7 | 5.0 (28.6%) | 7.0 (0.0%) | 0 (−1.50, 1.00) | p = 0.84 |
Normal work | 8 | 6.0 (25.0%) | 7.0 (12.5%) | −0.50 (−2.00, 1.00) | p = 0.41 |
Relations with other people | 5 | 5.0 (0.0%) | 5.0 (0.0%) | −0.50 (−1.50, 1.00) | p = 0.44 |
Sleep | 7 | 7.0 (0.0%) | 7.0 (0.0%) | 0 (−1.50, 1.00) | p = 0.68 |
Enjoyment of life | 6 | 6.0 (0.0%) | 7.0 (−16.7%) | 0 (−1.00, 1.50) | p = 0.73 |
Quality of Life Measure | Median SF-36 Score at Initial Visit | Median SF-36 Score at 3 Month Follow up | Median Difference (95% CI) | Change in SF-36 Scores (Initial Visit vs. 3 Month Follow up) |
---|---|---|---|---|
Physical functioning | 40 | 35 | −2.22 (−10.00, 7.78) | p = 0.71 |
Role limitations due to physical health | 0 | 0 | −12.50 (−25.00, 0) | p = 0.18 |
Role limitations due to emotional problems | 0 | 33 | 0 (−16.67, 33.33) | p = 0.41 |
Energy/fatigue | 25 | 25 | −2.50 (−10.00, 7.50) | p = 0.64 |
Emotional well-being | 52 | 56 | 0 (−10.00, 14.00) | p = 0.84 |
Social functioning | 50 | 50 | 12.50 (0, 25.00) | p = 0.17 |
Pain | 28 | 33 | 5.00 (−2.50, 12.50) | p = 0.33 |
General health | 35 | 40 | 2.50 (−5.00, 7.50) | p = 0.46 |
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Chen, M.; Patel, T.; Chang, F. The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study. Pharmacy 2020, 8, 113. https://doi.org/10.3390/pharmacy8030113
Chen M, Patel T, Chang F. The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study. Pharmacy. 2020; 8(3):113. https://doi.org/10.3390/pharmacy8030113
Chicago/Turabian StyleChen, Mo, Tejal Patel, and Feng Chang. 2020. "The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study" Pharmacy 8, no. 3: 113. https://doi.org/10.3390/pharmacy8030113
APA StyleChen, M., Patel, T., & Chang, F. (2020). The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study. Pharmacy, 8(3), 113. https://doi.org/10.3390/pharmacy8030113