Pharmacy Student Opioid Consultations with Standardized Limited English Proficiency Patients

Language barriers and postoperative opioid prescription use after total knee arthroplasty

Background

Patients with limited English proficiency (LEP) face difficulties in access to postoperative follow-up care, including post-discharge medication refills. However, prior studies have not examined how utilization of prescription pain medications after discharge from joint replacement surgeries differs between English proficient (EP) and LEP patients.

Objective

This study explored the relationship between English language proficiency and opioid prescription refill requests after hospital discharge for total knee arthroplasty (TKA).

Methods

This was an observational cohort study of patients ≥18 years of age who underwent TKA between January 2015 and December 2019 at a single academic center. LEP status was defined as not having English as the primary language and requesting an interpreter. Primary outcome variables included opioid pain medication refill requests between 0 and 90 days from discharge. Multivariable logistic regression modeling calculated the odds ratios of requesting an opioid refill.

Results

A total of 2148 patients underwent TKA, and 9.8% had LEP. Postoperative pain levels and rates of prior opioid use did not differ between LEP and EP patients. LEP patients were less likely to request an opioid prescription refill within 30 days (35.3% vs 52.4%, p < 0.001), 60 days (48.7% vs 61.0%, p = 0.004), and 90 days (54.0% vs 62.9%, p = 0.041) after discharge. In multivariable analysis, LEP patients had an odds ratio of 0.61 of requesting an opioid refill (95% CI, 0.41–0.92, p = 0.019) within 30 days of discharge. Having Medicare insurance and longer lengths of hospitalization were correlated with lower odds of 0–30 days opioid refills, while prior opioid use and being discharged home were associated with higher odds of opioid refill requests 0–30 days after discharge for TKA.

Conclusions

Language barriers may contribute to poorer access to postoperative care, including prescription medication refills. Barriers to postoperative care may exist at multiple levels for LEP patients undergoing surgical procedures.

Communication between patients and health care professionals about opioid medications

Prescription opioids contribute to 40% of opioid overdose deaths in the United States. Healthcare professionals (HCPs) play an important role in mitigating the prescription opioid epidemic by appropriate opioid prescribing and patient education. Yet, little empirical literature addresses pharmacist (and other HCP) communication with patients related to risks of opioid use associated with dependence, misuse, and overdose. Nor is there much research on the barriers and facilitators which affect whether and how much opioid-related information is discussed. This commentary, based on an extensive literature search, seeks to inform future communication, education, and research agendas by describing (1) topics commonly discussed or excluded from opioid medication counseling, (2) patient and HCP perceptions regarding opioid medication communication, and (3) barriers and facilitators to opioid risk communication. Based on this literature, recommendations are provided for opioid counseling practices, pharmacist education, and research agendas.

Student pharmacist opioid consultations with standardized limited English proficiency patients: A pre-post educational intervention study

BACKGROUND AND PURPOSE

This study explored the effect of a structured educational intervention for student pharmacists to counsel limited English proficiency (LEP) patients on risks and safety of opioid medications for chronic pain. Specific aims were to compare 2018 pre-intervention versus 2019 post-intervention groups regarding: (1) dose and side effects discussed, (2) opioid risks and safety measures covered, and (3) LEP specific communication practices.

EDUCATIONAL ACTIVITY AND SETTING

Third-year student pharmacists (P3s) in a required communications course consulted LEP standardized patients (SPs) on opioid medications in 2018 and 2019. An educational intervention for the 2019 P3s consisted of a 50-min lecture, pre-lab instructions about techniques for communication about opioid risks and safety, and for LEP specific communication stressing teach-back. All consultations in the pre- and post-intervention phases were video recorded and quantitatively coded for verbal and non-verbal communication skills. Descriptive statistics and Fisher's exact tests were conducted on data.

FINDINGS

Twenty-three consultations were recorded in 2018 for the pre-intervention phase and 49 consultations were recorded in 2019 for the post-intervention phase. Only 17% of students in the pre- intervention phase called the medication an "opioid" or "narcotic" in the consultation as compared to 84% in the post-intervention phase. While 100% of students in the post-intervention phase used teach-back, only 61% did so in the pre-intervention group. Significant differences between the two groups were observed for minimizing dependency and overdose, offering naloxone, teach-back, integrating a patient handout into the consultation, and discussing use of alternate pain medications.