Evaluating the Effect of COVID-19 on Outpatient Opioid Utilization Among Health First Colorado Members and a National Non-Medicaid Cohort: An Interrupted Time Series Analysis.

Objective: COVID-19, coinciding with the opioid epidemic in the United States, has had significant impacts on health-care utilization. While mixed, early analyses signaled a potential resurgence in opioid use following the pandemic. The primary study objective was to assess the association of the COVID-19 pandemic with opioid utilization among Health First Colorado (Colorado's Medicaid Program) members and a non-Medicaid managed care cohort who did not have a diagnosis of cancer or sickle cell disease. Patients and Methods: Using an interrupted time series and segmented regression analysis, this population-level study assessed the association of the COVID-19 pandemic on prescribed utilization of long- and short-acting opioid analgesics among Health First Colorado members and a random sample of non-Medicaid managed care members. Pharmacy claims data for both cohorts were assessed between October 1, 2018, and September 30, 2021, with April 2020 identified as the interruption of interest. We evaluated the following monthly opioid use measures separately for short-acting and long-acting opioids: number of members filling an opioid, total fills, and total days supplied. Results: Short- and long-acting opioid utilization was significantly decreasing among Health First Colorado members in the 18 months prior to the start of COVID-19. After the onset of the pandemic, utilization stabilized and slopes were not significantly different from zero. Among the non-Medicaid managed care cohort, short- and long-acting opioid utilization significantly decreased in the 18 months leading up to the onset of the pandemic. After the onset of the pandemic, utilization of long-acting opioids stabilized, while utilization of short-acting opioids significantly increased. Conclusion: While we observed an increase in opioid utilization measures post-pandemic in the non-Medicaid managed care cohort, a similar increase was not observed in Health First Colorado members suggesting that thoughtful opioid policies put in place pre-pandemic may have been effective at controlling potential inappropriate opioid utilization.

Evaluation of an opioid pain teleconsultation service to address the opioid overdose epidemic in Colorado: A Health First Colorado demonstration project.

BACKGROUND: Since the mid-1990s, more than 500,000 deaths have been attributed to the opioid overdose epidemic, which has created a serious national crisis affecting public health and social and economic welfare. To mitigate these opioid-related overdoses and deaths, interventions targeted at both the patient and community level are needed. OBJECTIVE: This demonstration project sought to determine whether implementation of a provider-to-provider opioid pain teleconsultation service with a pain specialist was correlated with a reduction in inappropriate opioid use and improve health outcomes. METHODS: Individual-level claims data for Health First Colorado Medicaid members were collected between March 1, 2017, and September 30, 2021, for individuals who triggered a provider-to-provider pain management teleconsultation based on receipt of a prescription for an opioid where the member was receiving a high-dose opioid (n = 125) or was opioid-naive (n = 819). The primary outcome measures were a patient's opioid dose less than 200 morphine milligram equivalent (MME) by 6 months after the consult if consult was triggered for high-dose use or discontinuation of an opioid by 12 weeks after consult if the consult was triggered for opioid naivety. Secondary opioid-related health outcomes were also assessed. RESULTS: In the high-dose opioid cohort, 87% of the members had their monthly average MME reduced to less than 200 by 180 days after their consult. More than half of the opioid-naive group had discontinued their opioid by 90 days after their consult. CONCLUSION: Results indicate that provider-to-provider teleconsultation services with a pain specialist can be an effective intervention at reducing total inappropriate opioid use.

Pharmacists Are Not Mid-Level Providers.

Pharmacists should not be classified as "mid-level" providers. This classification implies that there are different levels or a hierarchy of providers when in fact each health care provider brings unique and essential knowledge and contributions to the health care team and to the care of patients. Pharmacists are no exception. Timely issues germane to pharmacists, including dependent and independent practice, provider status, and professional identity, contribute to the rationale that pharmacists, just like all other health care providers, should be classified by their professional identity. While use of the term mid-level provider to identify various practitioners may not seem consequential, in today's health care environment, words do matter when it comes to attributing value, and the contributions of all health care providers should be recognized as equally important to the patient care team.

The Report of the 2020-2021 Professional Affairs Standing Committee: Pharmacists' Unique Role and Integration in Healthcare Settings.

EXECUTIVE SUMMARY The 2020-21 Professional Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to the committee's work this year; (2) Identify opportunities and models of integration of pharmacist care services in physician and other health provider practices beyond primary care; (3) Differentiate and make the case for the integration of pharmacist care services from that of other mid-level providers; and (4) From the work on the aforementioned charges, identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides information on the committee's process to address the committee charges, describes the rationale for and the results from a call to colleges and schools of pharmacy to provide information on their integrating pharmacist care services in physician and other health provider practices beyond primary care practice, and discusses how pharmacist-provided patient care services differ from those provided by other healthcare providers. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to CTAP and AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

The Report of the 2019-2020 Professional Affairs Standing Committee: Pharmacist Integration with Primary Care Practices.

The 2019-2020 Professional Affairs Committee was charged to (1) Describe the leadership role of schools of pharmacy in advancing interprofessional practice, with an emphasis on physician-pharmacist collaborative relationships; (2) Establish an inventory of resources that can support school efforts to grow collaborative partnerships between pharmacists and physicians; (3) Determine gaps that exist in the resources required to support schools in efforts to facilitate expansion of interprofessional partnerships; and (4) Define strategies and draft an action plan for AACP's role in facilitating member school efforts to accelerate the development of interprofessional practices within their geography of influence. This report provides information on the committee's process to address the committee charges as well as background and resources pertaining to the charges, describes the rationale for and the results from the focus groups conducted at the 2020 AACP Interim Meeting, communicates the results of an initial inventory of models that integrate pharmacists with primary care practices, and provides an overview on issues to continue the work to integrate pharmacists with primary care practices. The committee offered several revisions to current association policy statements and provided a proposed policy statement and several recommendations to AACP pertaining to the committee charges.

Report of the 2017-2018 Strategic Engagement Standing Committee.

EXECUTIVE SUMMARY Student engagement is key to the success of schools and colleges of pharmacies in meeting their mission and programmatic needs. Student engagement in the pharmacy profession often occurs before acceptance to pharmacy school and is essential during students' formal period of study both for the student's professional growth and in meeting the mission of the school. Alumni engagement is vital to a school's continued success in regard to engaging with current students and support of their alma mater. The committee offers best practice recommendations for engaging students in service, scholarship, education, professional practice and continuing professional development.

Expansion of clinical pharmacist positions through sustainable funding.

PURPOSE: Expansion of clinical pharmacist positions through sustainable funding is described. SUMMARY: The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences was awarded a 2-year program grant to establish an integrated clinical pharmacy program for underserved residents in family health centers in northeastern Colorado. The grant enabled the hiring of 2 bilingual, full-time, board-certified, postgraduate year 2-trained clinical pharmacists to initiate comprehensive clinical pharmacy services. Clinical pharmacy services for diabetes, hypertension, and dyslipidemia management were provided during direct patient care visits using collaborative drug therapy management protocols to facilitate comprehensive medication management. Initial visits lasted 1 hour, and follow-up visits lasted 30 minutes. In addition, clinical pharmacists provided point-of-care consultations for patients seeing other healthcare providers. All patient encounters and consultations were documented in the electronic health record. Success of the clinical pharmacy program was evaluated based on the achievement of goal blood pressure values, glycosylated hemoglobin values, and low-density-lipoprotein cholesterol levels. Pharmacists' involvement in patient care activities led to improvements in all of these clinical outcomes. This coincided with unique funding opportunities with regional accountable care organizations that sought to demonstrate improved patient care in an expansion population. As a result, 2 grant-funded clinical pharmacist positions in 2 community health clinics were converted into 4 faculty positions in 5 community health centers funded by regional accountable care organizations. CONCLUSION: Collaboration with accountable care organizations resulted in the successful funding of ambulatory care clinical pharmacy services. These services resulted in improved chronic disease control and provider satisfaction.

Quality of drug information database research for clinical decision support.

This commentary identifies studies that have compared commercially available DI databases, and discusses improvements in study methodology that might better guide clinicians in selecting resources for their practice setting. We also provide suggestions for future direction of research in this area with an eye towards clinical decision support systems (CDSS). The body of comparative research of commercially available DI databases is small, and provides little value to the average clinician when making purchasing decisions. Transparency of study methodology would allow readers to choose a database that best fits their practice needs. Future research must consider how DI resources are imbedded within CDSS, such that the alerts generated by the CDSS are consistent with the primary DI workhorse of the practice site. Cohesion between CDSS and DI resources needs to be a consideration in future DI resource comparative research.

Fospropofol: a new sedative-hypnotic agent for monitored anesthesia care.

OBJECTIVE: To summarize the published clinical data on fospropofol, critically review the safety and efficacy information, and provide pertinent information for formulary review. DATA SOURCES: Data were collected from searches of MEDLINE (1966-June 30, 2009), EMBASE (1974-June 30, 2009), bibliographies of manuscripts, and www.fda.gov. Key search terms included fospropofol, Lusedra, Aquavan, sedative-hypnotic, and monitored anesthesia care. STUDY SELECTION AND DATA EXTRACTION: All Phase 1, Phase 2, and Phase 3 clinical trials studying the safety and efficacy of fospropofol were reviewed. DATA SYNTHESIS: Fospropofol is a water-soluble prodrug of propofol, a potent sedative-hypnotic agent. Propofol is highly lipophilic and is formulated in lipid-containing solvents, which have known disadvantages, including pain on injection, narrow therapeutic window with the potential to cause deep sedation, high lipid intake during long-term sedation, and risk of infection resulting from bacterial contamination. Due to its water solubility, fospropofol eliminates some of the known lipid emulsion-associated disadvantages of propofol and provides a more predictable peak onset of activity and more gradual recovery to a full state of consciousness. The pharmacokinetic and pharmacodynamic profiles of fospropofol make it an attractive agent for sedation for procedures of short duration. Unfortunately, the number of patients studied has been relatively small and the amount of safety data is limited. Of concern are reports of hypoxemia and hypotension; these reports are limited in number, but the episodes are serious and may require acute intervention. Although fospropofol holds promise for procedural sedation, due to limited safety data, the Food and Drug Administration has limited approval of fospropofol to monitored anesthesia care in patients undergoing diagnostic or therapeutic procedures. CONCLUSIONS: Fospropofol is a viable addition to the class of sedative-hypnotic agents due to the minimization of unwanted adverse effects of propofol and maintenance of a favorable pharmacokinetic profile facilitating sedation, anxiolysis, and rapid recovery. However, there are limited safety data to justify its use without the presence of dedicated anesthesia personnel.