Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study

Tim Tran; James Ford; Andrew Hardidge; Shari Antoine; Beth Veevers; Simone Taylor; Rohan A Elliott

doi:10.1007/s11096-022-01455-y

Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study

Int J Clin Pharm. 2022 Dec;44(6):1269-1276. doi: 10.1007/s11096-022-01455-y. Epub 2022 Jul 12.

Authors

Tim Tran^{1

2}, James Ford³, Andrew Hardidge⁴, Shari Antoine⁵, Beth Veevers⁵, Simone Taylor³, Rohan A Elliott^{3

6}

Affiliations

¹ Pharmacy Department, Austin Health, Heidelberg, VIC, Australia. tim.tran@austin.org.au.
² Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia. tim.tran@austin.org.au.
³ Pharmacy Department, Austin Health, Heidelberg, VIC, Australia.
⁴ Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia.
⁵ Health Independence Program, Austin Health, Heidelberg, VIC, Australia.
⁶ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.

Abstract

Background: More than 70% of patients continue to use opioid medications 3-weeks following total knee arthroplasty. Post-discharge pharmacist reviews improve medication management, however it's effect on opioid usage is not known.

Aim: This study aimed to evaluate the impact of post-discharge pharmacist review on opioid use following a total knee arthroplasty.

Method: A pilot, cohort pre- and post-intervention study was undertaken on patients who had undergone a total knee arthroplasty and were supplied an opioid upon discharge from hospital. During the intervention, patients were contacted via telephone by a pharmacist approximately five days post-discharge to review analgesic usage, provide education and advice and communicate an opioid management plan to their general practitioner. The primary endpoint was the percentage of patients taking opioids 3-weeks post-discharge. Secondary endpoints included: percentage of patients obtaining an opioid refill; patient satisfaction with opioid supply and the pharmacist review.

Results: Pre- and post-intervention, 63 and 44 patients were included, respectively. The percentage of patients taking opioids 3-weeks post-discharge declined from 74.6 to 29.6% (p < 0.001) and the percentage requiring an opioid refill from their general practitioner declined from 71.4 to 36.4% (p < 0.001). More patients were satisfied with opioid supply during the intervention period (79.5% cf. 47.6%, p = 0.001). Twenty-eight (63.6%) patients could recall the post-discharge pharmacist review, and all were either satisfied or extremely satisfied with the review.

Conclusion: Pharmacist-delivered post-discharge analgesia review reduced the percentage of patients taking opioids 3-weeks post-discharge following a total knee arthroplasty. This intervention has the potential to provide a smoother transition of care for patients supplied with opioids at the time of hospital discharge.

Keywords: Opioids; Orthopedic surgery; Pharmacist; Transitions of care.

MeSH terms

Aftercare
Analgesics, Opioid* / therapeutic use
Arthroplasty, Replacement, Knee* / adverse effects
Cohort Studies
Humans
Pain, Postoperative / drug therapy
Patient Discharge
Pharmacists

Substances

Analgesics, Opioid