8 pharmacy track pharmacists working with local coalitions and pdm ps

Pharmacy Track:Pharmacists Working with

Local Coalitions and PDMPsPresenters:

• Nicole O'Kane, PharmD, Clinical Director, Acumentra Health

• Kristina Clark, CPS-II, Executive Director, Coffee County (TN) Anti-Drug Coalition

• Christina Merino, CPS-II, Prevention Coordinator, Coffee County (TN) Anti-Drug Coalition

Moderator: Michael H. Ghobrial, PharmD, JD, Associate Director, Health Policy, American Pharmacists Association, and Member, Rx Summit National Advisory Board

Disclosures

• Nicole O'Kane, PharmD; Kristina Clark, CPS-II; Christina Merino, CPS-II; and Michael H. Ghobrial, PharmD, JD, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

Disclosures

• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

• The following planners/managers have the following to disclose:– Kelly Clark – Employment: Publicis Touchpoint Solutions;

Consultant: Grunenthal US– Robert DuPont – Employment: Bensinger, DuPont &

Associates-Prescription Drug Research Center– Carla Saunders – Speaker’s bureau: Abbott Nutrition

Learning Objectives

1. Identify ways pharmacists may contribute to the reduction of Rx drug abuse, misuse and diversion.

2. Explain the critical role for pharmacists in collaborative and outreach efforts to reduce Rx drug abuse, misuse and diversion.

3. Describe how pharmacists may utilize the PDMP to screen for potential safety concerns.

4. Specify recommendations for optimizing pharmacists’ use of the PDMP to improve patient care.

Pharmacist’s Role in Addressing Addiction and Diversion: PDMP as

an Important Clinical Tool

Nicole O’Kane, PharmDClinical Director

Acumentra Health

Disclosure Statement

Nicole O’Kane, PharmD, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.

Learning Objectives

1. Describe how pharmacists may utilize the PDMP to screen for potential safety concerns.

2. Specify recommendations for optimizing pharmacists’ use of the PDMP to improve patient care.

Outline

1. Introduction

2. The expanding role of pharmacists

3. Practitioner use of the Oregon Prescription Drug Monitoring Program (PDMP)

4. Oregon initiatives

Acumentra Health

• Portland-based nonprofit consulting firm, dedicated to improving quality, safety, and effectiveness of health care

• Collaborate with practitioners in all care settings, and with purchasers, community-based organizations, professional associations, policy makers, and consumers

www.acumentra.org

Use of Prescription Monitoring Programs to Improve Patient Care and Outcomes

• 5-year grant (2012‒2017) to study effectiveness of the Oregon Prescription Drug Monitoring Program as a clinical decision tool for prescribers of controlled substance medications

Supported by the National Institutes of Health, National Institute for Drug Abuse through Grant # 1 R01 DA031208-01A1, and by the National Center for Research Resources and the National Center for Advancing Translational Sciences, through grant UL1RR024140

Study Aims

AIM 1:Determine the prevalence and characteristics of PDMP users and non-users

AIM 2:Determine how providers use PDMP data; formulate recommendations for clinical guidelines

AIM 3: Determine whether PDMP use improves patient outcomes and reduces apparent diversion/abuse

Pharmacists in Health Care

• Community pharmacies

• Hospital systems

• Primary care clinics

• Specialty care

• Home infusion

• Long-term care settings

• Health plans

• Public heath policy

12

Pharmacists in Health Care

Community pharmacists

Clinical pharmacists

The expanding role of pharmacists

Pharmacist Responsibility

The dispensing pharmacist is in the same position as the practitioner who issued the prescription and must exercise professional judgment to determine whether a prescription for a controlled substance was issued for a legitimate reason.

DEA regulations (21 CFR §1306.04)

http://deachronicles.quarles.com/2013/08/a-pharmacists-obligation-corresponding-responsibility-and-red-flags-of-diversion/

Pharmacist Responsibility

Assessment of each patient and prescription:

• Legitimate medical need

• Possible intent to divert or misuse controlled substances

• Possible addiction that requires appropriate referral and treatment

Pharmacist Survey Results

• PDMP perceived as a valuable screening tool

• Half report receiving training in identifying prescription drug diversion, abuse, or addiction

• Interest in screening and discussing misuse

Cobaugh, D. J., et al. Am J Health Syst Pharm, 2014;71(18), 1539-1554.Gavaza, P., et al. Res Social Adm Pharm, 2014;10(2), 448-458.Hagemeier, N. E., et al. Subst Use Misuse, 2013;48(9), 761-768.Cochran G., et al. J Pharm Pract. 2014 Feb 13 [epub ahead of print]

Pharmacist Survey Results

• Potential safety concerns prompt additional actions

– Contact prescriber

– Contact other pharmacies

– Specific patient counseling or referral

– Deny prescription

Pharmacist Use of PDMP

• New corporate policies include additional requirements and documentation

– Prevent diversion or abuse

– Concerns about access for legitimate pain need

• Barriers to workflow integration

• Lack evidence on best practices

http://www.nabp.net/system/rich/rich_files/rich_files/000/000/209/original/consensus-document.pdf

Oregon PDMP

This program seeks to promote public health and welfare and help improve patient care. The information helps healthcare providers and pharmacists to better manage patients' prescriptions to improve quality of care. It also supports the appropriate use of prescription drugs.

http://www.orpdmp.com

Oregon PDMP

• Program began data upload June 2011

• Oregon National Governor’s Association Task Force on Prescription Drug Abuse 2012

• PDMP enhancements include allowing delegate users starting January 2014

http://www.orpdmp.com

Cumulative Number of System Accounts by Discipline

Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

New System Accounts by Discipline

Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

Users Submitting Queries by Discipline

Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

Number of System Queries by Discipline

Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports: http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

Oregon Initiatives

• Medically supervised lay person naloxone rescue program

• Coordinating efforts across systems

– Methadone removed from state formulary

– Community take-back days

– Oregon Pain Guidance website:

www.southernoregonopioidmanagement.org

http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf

A Socio-Ecological Model

Organizationalorganizations,

social institutions

Individualknowledge,

attitudes, skill

Interpersonalfamily, friends, social networks

Communitycounty, town, neighborhood

Society & public policynational, state, and local

laws and regulations

26

“To stem the tide of the unintended consequences of the promotion of drug use it will be necessary for health systems, clinicians, academics, epidemiologists, patients, pharmacists, communities, law enforcement, and pain specialists to work together. “

- Drug Overdose Deaths, Hospitalizations, Abuse and Dependency among Oregonians Report 2014

http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf

Pharmacists Working with Local

Coalitions and PDMPs

Kristina Clark, Executive Director

&

Christina Merino, Prevention Coordinator

Coffee County Anti-Drug Coalition, Tennessee

Disclosure Statements

• Kristina Clark, CPS II, Executive Director, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods or services.

• Christina Merino, CPS II, Prevention Coordinator, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods or services.

Learning Objectives

1. Identify ways pharmacists may contribute to

the reduction of Rx drug abuse, misuse and

diversion.

2. Explain the critical role for pharmacists in

collaborative and outreach efforts to reduce

Rx drug abuse, misuse and diversion.

Strategic Prevention

Framework

5 steps of effective prevention

Assessment

The Problem: Non-Medical Use of Prescription Drugs

Contributing

Factors:

Community Based

A. Ease of Access

1. Home

2. School

B. Perception of Harm

1. of Parents

2. of Youth

Access Harm Abuse

Capacity & Planning

Medical Professional Forum

• Key Stakeholders

• Implements

• Time Constraints

Communication Plan

• Accountability for

Deliverables

• Strategic Targeting

- Pharmacies

- Doctors

- Dentists

• Action PlanningFocus Groups

Plan

TeamAction!

Taking Rx Abuse Prevention One Step

Further than PDMP’s

Indicated

Selective

Universal

Community Level Change

Education

Written Prescription

ConsultationPrescription

Obtained

Behavior Change

Implementation

Evaluation

Dropped 30 day

prescription drug use by

approximately 25% in 6th,

8th, 10th, and 12th grades.*

Increased by 20% the number of youth with clear family rules concerning alcohol, tobacco, and other drugs.*

Increased by 18% the number of 10th and 12th

graders reporting that it is harder to get prescription drugs.*

*2009 compared to 2012 Student Survey Data

Evaluation

Increased from 0% to 24% the number of community members who report locking up their medications.*

Decreased by 24% the number of community members reporting keeping prescription medications.*

Increased community members tracking medications from 0% to 21%.*

Decreased by 50% the students reporting sharing prescription drugs (2009 compared to 2012 Student Survey Data).

*2009 compared to 2012 Drug Take Back Survey Data

Questions

Thank you for your time and attention.

Kristina Clark

[email protected]

Christina Merino

[email protected]

Coffee County Anti-Drug Coalition

(931) 570-4484 – Office

(931) 570-2361 - Fax

Pharmacy Track:Pharmacists Working with

Local Coalitions and PDMPsPresenters:

• Nicole O'Kane, PharmD, Clinical Director, Acumentra Health

• Kristina Clark, CPS-II, Executive Director, Coffee County (TN) Anti-Drug Coalition

• Christina Merino, CPS-II, Prevention Coordinator, Coffee County (TN) Anti-Drug Coalition

Moderator: Michael H. Ghobrial, PharmD, JD, Associate Director, Health Policy, American Pharmacists Association, and Member, Rx Summit National Advisory Board