Developing an interprofessional team to support patients prescribed long-term high-dose opioid therapy.

Despite decreases in US opioid prescribing rates, daily morphine milligram equivalents (MME) prescribed per person remains three times higher than in 1999. An interprofessional team (IPT) was developed to support pain management for patients prescribed long-term high-dose opioids (HDO) in a Federally Qualified Health Center. The IPT utilized a clinical pharmacist, addiction nurse, medical director, and another physician or nurse practitioner to manage adults prescribed long-term HDO, defined as exceeding 50 daily MME. Visits focused on patient education including risks associated with long-term HDO use and effective pain management. The IPT engaged in supportive, individualized care planning for safer, evidence-based pain management, which included, but was not limited to opioid tapers, adjuvant non-opioid pain medications (NOPM), non-pharmacological therapy (NPT), and naloxone co-prescribing. The IPT saw 90% (n = 19) of eligible patients. Excluding outliers, the cohort demonstrated an average 18% ± 24.9 decrease in daily MME. The most common NOPM were acetaminophen, NSAIDs, and pregabalin, and the most common NPT were physical, aquatic, and behavioral therapy. Shared decision-making, collaborative teamwork, and simple patient-centered goals are key to moving patients toward safer, evidence-based therapy.

Stronger, longer, better opioid antagonists? Nalmefene is NOT a naloxone replacement.

The fatal overdose crisis claims nearly 200 lives daily in the United States (U.S). Evolutions in the illicit drug supply, such as the addition of sedative adulterants and a shift to synthetic opioids such as fentanyl, have driven increasing rates of both fatal and non-fatal overdose. Specifically, synthetic opioid usage of fentanyl was implicated in 68 % of the U.S. drug overdose deaths in 2022 alone. This has placed tremendous burden on communities, emergency medical services, and healthcare systems, and contributed to tragedy and grief both in the U.S. and worldwide. Despite the availability of effective opioid antagonist medications and standards of care, there has been increased interest in research and development of alternative opioid overdose reversal agents by the National Institutes of Health (NIH) in partnership with pharmaceutical manufacturers over the last decade. The U.S. Food and Drug Administration (FDA) recently approved nalmefene (Opvee) a mu-opioid receptor antagonist that boasts an extended half-life and stronger mu-receptor affinity compared to the standard of care use of naloxone for opioid reversal. In this article, we explore the medical need and ramifications of the introduction of longer-acting opioid antagonists in the current opioid overdose landscape. Existing data highlight the effectiveness of already available naloxone products as a safe and effective standard of care. These data support the notion that stronger, longer-acting agents may be unnecessary, and their existence may cause undue harm, such as more severe and/or prolonged withdrawal symptoms, lead to challenging patient interactions, and complicate the initiation of medications for opioid use disorder. More evidence is needed before healthcare professionals should implement the use of stronger, longer-acting opioid antagonists for reversing opioid overdose over evidence-based, cost-effective naloxone.

Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions.

OBJECTIVE: This study aimed to define competency-based education (CBE) for pharmacy education and describe how strengths and barriers of CBE can support or hinder implementation. FINDINGS: Sixty-five studies were included from a variety of health professions in order to define competency based pharmacy education (CBPE) and identify barriers and benefits from the learner, faculty, institution, and society perspectives. From the 7 identified thematic categories, a CBPE definition was developed: "Competency-based pharmacy education is an outcomes-based curricular model of an organized framework of competencies (knowledge, skills, attitudes) for pharmacists to meet health care and societal needs. This learner-centered curricular model aligns authentic teaching and learning strategies and assessment (emphasizing workplace assessment and quality feedback) while deemphasizing time." SUMMARY: This article provides a definition of CBE for its application within pharmacy education. The strengths and barriers for CBE were elucidated from other health professions' education literature. Identified implementation strengths and barriers aid in the discussions on what will support or hinder the implementation of CBE in pharmacy education.

Patient experiences of buprenorphine dispensing from a mobile medical unit.

BACKGROUND: Overdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates. METHODS: All patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis. RESULTS: 106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment. CONCLUSIONS: Mobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit's buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments.

The Need for Quality Assessment of Entrustable Professional Activities in Pharmacy Education.

Entrustable professional activities (EPAs) are specific tasks that a professional is entrusted to perform autonomously and, together, they define the scope of a profession. There are specific attributes that a task must possess both structurally and conceptually to be classified as an EPA. A high-quality EPA must be an observable, measurable, and professional task that requires training to execute, is fit for entrustment, and can be performed independently. In 2017, the American Association of Colleges of Pharmacy (AACP) defined 15 core EPAs expected of a pharmacy learner upon graduation (Core EPAs). Despite acceptance and implementation by pharmacy schools across the country, the Core EPAs have not been evaluated using an objective assessment tool to ensure that they meet specific EPA quality standards outlined in the literature. This article describes existing objective assessment tools for EPA quality and highlights the importance of ensuring high-quality EPAs in pharmacy education, which would be an important step for the AACP Academic Affairs Committee to take to further develop EPAs for implementation.

Which Entrustment-Supervision Scale is Right for Pharmacy Education?

Entrustable professional activities (EPAs) are an outgrowth of the competency-based educational model to support workplace-based learner assessments and evaluation. A learner's performance of EPAs is assessed by the degree of provided entrustment and required supervision rather than by a score, percentage, or letter grade typically assigned in traditional academic coursework. Entrustment-supervision (ES) scales are used to document learner progression and steer learner development over time. The purpose of this article is to critique various ES tools in health professions education for utilization within an EPA framework for learner assessment in workplace-based settings and to determine which will best suit pharmacy education. Exploring the advantages and disadvantages across all types of ES scales is a critical step in determining the most useful ES tool for use within a specific pharmacy institution and across the Academy. An ES scale with the traditional 5 levels, a prospective assessment frame, and increased stratification at lower levels should be recommended by the Academy and utilized in workplace-based settings for formative and summative assessment to provide more valid assessment of learners, support the ideal of life-long learning, and give more meaning for pharmacy faculty and learners within assessment.

Evaluating the Quality of the Core Entrustable Professional Activities for New Pharmacy Graduates.

This study aimed to evaluate the quality of the American Association of Colleges of Pharmacy Core Entrustable Professional Activities (Core EPAs) for New Pharmacy Graduates according to standards outlined in competency-based education literature utilizing the Queen's EPA Quality (EQual) rubric. A cohort of pharmacists with EPA expertise rated Core EPA quality with the EQual rubric and provided recommendations for revisions. A generalizability study determined the reliability of the EQual ratings with pharmacist users. Nine pharmacists responded (4.4%). Most EPAs (9/15) did not reach the overall cut-off score, indicating low quality. EPAs 1 through 5 and EPA 14 (fulfill a medication order) were deemed high quality. EPA 12 (use evidence-based information to advance patient care) scored the lowest at 3.47 (SEM 0.29). EPA 14 scored the highest at 4.60 (SEM 0.14). EPA 15 (create a written plan for continuous professional development) was the only EPA to fail to reach the cut-off across all EQual domains. EPAs in the Patient Care Provider Domain received significantly higher ratings than other EPAs. On average, three respondents recommended revision for each. Most comments aligned with the EPA's EQual rubric performance. The generalizability study analysis revealed excellent reliability (G = 0.80). Determining EPA quality utilizing objective measurement tools should drive EPA development and revisions to more accurately reflect the roles, responsibilities, and expectations of pharmacists on the healthcare team.

Patient with newly diagnosed type 2 diabetes? Remember these steps.

In addition to promoting glycemic control, you'll need to initiate statin therapy for CV risk, administer appropriate vaccinations, and screen for depression regularly.

Medication-assisted recovery for opioid use disorder: A guide.

Considering offering medical intervention for OUD to reduce mortality? It's essential to understand the clinical benefits, limitations, and regulation of available agents.

Outcomes of a mobile medical unit for low-threshold buprenorphine access targeting opioid overdose hot spots in Chicago.

INTRODUCTION: Opioid overdoses in Chicago are unevenly distributed, affecting medically underserved neighborhoods most acutely. Innovations in reaching patients perceived to be hard-to-reach (e.g., unstably housed, marginalized), especially in these underserved neighborhoods, are urgently needed to combat the overdose crisis. This study characterizes the pilot year of a mobile medical unit partnership between a large urban academic center and a community-based harm reduction organization in Chicago. METHODS: This is a retrospective cohort study of all patients who were seen on a mobile medical unit focused on providing low-threshold buprenorphine and primary care in areas with high opioid overdose rates on Chicago's West Side. Treatment episodes were accrued between July 1, 2021, and June 30, 2022 in the first year of operation. The main outcomes were number of patients seen, demographic characteristics of patients, and reason(s) for visit over time. RESULTS: The study saw 587 unique patients on the mobile medical unit between July 1, 2021, and June 30, 2022. Approximately 64.6 % were African American, and more than half lacked active insurance or could not confirm insurance status at the time of visit. The most common reason for initial visit was COVID-19 vaccination (42.4 %), and the most common reason for follow-up visit was buprenorphine treatment (51.0 %). Eleven patients initially presented for other health concerns and later returned to initiate buprenorphine. CONCLUSIONS: The mobile medical unit successfully reached nearly 600 patients in traditionally medically underserved Chicago neighborhoods with the highest overdose rates. The mobile unit's integrated approach met a variety of health needs, including buprenorphine initiation, with a unique opportunity for postoverdose initiation. Several patients initiated buprenorphine after presenting for different health concerns, showing the potential of an integrated approach to build on past mobile outreach programs and reach people with opioid use disorder who are not yet ready to initiate treatment.

Urban Expansion of the SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness Initiative for Home Health Workers and Older Adults.

The SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness pilot program utilized home health workers (HHWs) in rural settings to educate older adults prescribed opioids on naloxone access and use. This work expands the SAFE-HOME program to urban settings to prepare HHWs to educate community-dwelling older adults on opioid risks and life-saving naloxone. This prospective, interventional cohort study evaluated 60-min synchronous, virtual HHW educational training sessions describing opioid risks in older adults, opioid overdose signs and symptoms, and naloxone access and use. Knowledge assessments were conducted pre- and post-intervention via a pre-developed assessment tool in a repeated measure model. Outcomes included change in total opioid and naloxone knowledge, and baseline total and individual opioid and naloxone knowledge. Six educational sessions were held (n = 154). The average pre- and post-education scores were 62.7% (n = 108) and 83.5% (n = 82), respectively (p < 0.001). Of the 69 participants who completed both pre- and post-education assessments, the average change in total score was +19.6% (p < 0.001), opioid knowledge score -0.4% (p = 0.901), and naloxone knowledge score +32.9% (p < 0.001). At baseline, HHWs were knowledgeable on opioid risks, but lacked familiarity with naloxone access and use. Targeting HHWs with opioid and naloxone training positions them to effectively educate at-risk community-dwelling older adults.