Interprofessional care involving pharmacists crucial in improving outcomes of pain management
Pharmacists play a unique role in patient care as they are trained in pharmacology, pharmacokinetics and therapeutic efficacy of analgesic medications, says Nur Hazalina Md Salleh, pharmacist at Hospital Sultan Ismail in Johor Bahru.
Pharmacists may also be involved in purchasing of medications, so they know the cost of medications and can help to safeguard cost effectiveness and safe practice of pain medications while improving patients’ quality of life, she added, speaking at the 3rd National Pain Free Conference 2018 in Putrajaya.
“The complexity of patients and their treatment regimens in pain management requires access to providers who can manage patients’ medication therapy, identify adverse events and manage drug-related problems,” she said.
In terms of pain medicines and safety, analgesics are among the most frequently reported drugs for each adverse drug reactions. The National Pharmaceutical Regulatory Agency (NPRA), Malaysia had stated 1,575 adverse drug reaction (ADR) cases reported in 2017 involving 14 types of NSAIDs.
The most frequent ADRs reported were skin and subcutaneous disorders (48%) and eye disorders (29%); others include respiratory, thoracic and mediastinal disorders (10%); systemic and local administration site reactions (7%), and gastrointestinal disorders (6%). Therefore, it is crucial for pharmacists to identify and monitor these ADR to ensure patient safety, she said.
In technical roles, pharmacists procure, store and secure pain medication and ensure all the processes and procedures comply with the relevant guidelines, rules and regulations. Pharmacists are responsible to establish an effective distribution system of medications and also prepare and dispense medicinal products.
In clinical roles, pharmacists provide effective pain medication therapy management (MTM). Pain MTM services provided by trained pharmacists include monitoring and counselling with the goals of providing education, improving adherence or detecting adverse drug events and medication misuse, as well as ensuring pain medicinal products are secured.
Provision of pain MTM service includes assessing patients’ health status and medication history by conducting a thorough medication history assessment; managing patients’ medication therapy; establishing pharmaceutical care plan to address pharmaceutical care issues; monitoring patients’ progress, outcomes of treatment and medication safety issues; and providing information about medicines and other health-related issues.
Pain MTM services can be provided both in ambulatory and inpatient setting. In the ambulatory setting, pharmacists in collaboration with other healthcare professionals can manage pain MTM clinic. Patients may be referred by a pain specialist, family medicine specialist (FMS) or selected by the pharmacist in the clinic. These patients include those with changes in pain medication regimen; experiencing side effects or complications due to their pain medications; those on strong opioids therapy, and those with poor understanding on pain medication regimen.
In pain MTM clinics, pharmacists educate and guide patients in managing and controlling their pain through pharmacotherapy approach. Pain MTM clinics are based on guidelines published by Pharmaceutical Services Programme, MOH with the second edition published in 2018.
[Available at: www.pharmacy.gov.my or www.moh.gov.my]
Nur Hazalina emphasized that pharmacists play an important role in facilitating seamless care to promote better pain management and overall health outcomes. Pharmacists can play an active part in the management of both acute and chronic pain by ensuring safe and appropriate use of medications, and counselling and educating patients, caregivers and other healthcare staff about medication therapy.