Hospital consumer assessment of healthcare providers and systems scores relating to pain following the incorporation of clinical pharmacists into patient education prior to joint replacement surgery

Predictors of Pain Management Outcomes Following Orthopaedic Surgery: A Systematic Review

BACKGROUND

Up to 80% of patients in the United States report dissatisfaction with pain management following orthopaedic surgery. Inadequate pain management is linked to negative outcomes, including increased costs, readmission rates, and chronic pain risk. Traditional pain management protocols often emphasise the biological components of pain, overlooking psychological and social. This systematic review addresses this gap by answering two key questions: (1) What factors are associated with increased risk of unsatisfactory pain management following orthopaedic surgery? (2) What are the key components of successful pain management protocols following orthopaedic surgery?

METHODS

PRISMA guidelines were followed with a search of relevant online databases. Studies were included if they were in English, provided patient feedback/satisfaction with pain management (quantitative studies) or provided satisfaction with pain management or healthcare team feedback (qualitative studies) or explored patient variables associated with satisfaction with pain management.

RESULTS

Of the 845 articles screened, 27 met the inclusion criteria. Synthesis suggested that while perceived severity and duration of pain are often assumed to be the primary drivers of patient satisfaction related to pain management, patients with a sense of control over their pain reported higher satisfaction, regardless of actual pain level. History of opioid misuse, patient expectations, and patient mental health were associated with dissatisfaction.

CONCLUSION

Pre-operative education and ongoing communication, particularly regarding patient risk-factors and multi-modal pain management strategies, appear to enhance patients' sense of control and satisfaction. Future research should explore whether individualised pre-operative education can improve satisfaction with post-surgical orthopaedic pain management.

Are we educating patients about postoperative analgesics following orthopaedic surgery? A scoping review

OBJECTIVES

To identify interventions educating patients undergoing orthopaedic surgery about postoperative analgesics and explore their associated outcomes.

METHODS

A scoping review using six databases was conducted. Eligible interventions were delivered to adult patients undergoing open orthopaedic procedures that could be feasibly implemented into any setting. Content, delivery methods and outcomes for interventions were described where available.

RESULTS

Eleven studies were included. Content and delivery methods differed substantially. Eight studies aimed to reduce postoperative harm by reducing opioid consumption. Studies also explored pain control (n = 6) and patient satisfaction (n = 4). Health literacy was not assessed in any study. Previous surgical or analgesic experience was infrequently reported.

CONCLUSION

This is the first scoping review assessing globally adaptable interventions designed to educate orthopaedic patients about postoperative analgesics. A paucity of interventions was found, with a limited range of patient-centred outcomes assessed. Further research is required. Co-designed educational materials with patients is recommended.

PRACTICE IMPLICATIONS

Despite the unclear benefit, clinicians should consider providing postoperative analgesic education to patients. Well-designed education has the potential to improve quality of life at low cost with low risk. Educational material adapted to local health literacy levels and prior surgical and analgesic experience is recommended to maximise engagement and impact.

An Analysis of Medication Adherence in a Large Outpatient Population During the COVID-19 Pandemic Using a Novel Value-Based Pharmacy System

Background: Adherence to a medication regimen is defined as taking the medication as directed by the prescriber. Adherence is critical to achieve the desired therapeutic outcomes. Medication adherence has not been examined in large outpatient populations since the onset of the COVID-19 pandemic. A novel outpatient value-based pharmacy system (VPS) was used to collect adherence data from a large, outpatient population. The aim of this descriptive study was to analyze the reasons, medication classes, and diagnoses associated with nonadherence. Materials and Methods: Telepharmacist-documented adherence data from a large (n = 6,479) outpatient population that received remote consultation during the COVID-19 pandemic (August 1, 2020-November 28, 2022) were considered for this study. The adherence data were compiled within the VPS. Results: The overall rate of patients reporting at least one incident of nonadherence to their medication regimens was 21.5%. Medications used to treat hypertension, type 2 diabetes, and hyperlipidemia were least adhered to. Statins, beta-2 agonists, and corticosteroids were least adhered to. The most common reasons for nonadherence included knowledge gaps regarding therapy, forgetfulness, and side effects. Discussion: This represents the first descriptive analyses of adherence metrics in a large outpatient population during the COVID-19 pandemic. Polypharmacy, prevalence of diagnosis, and medication side effect profile may have contributed to the results observed. This study demonstrates the ability of a VPS to document key data to better inform the health care team. Elucidating adherence metrics in such populations may allow pharmacists and prescribers to identify subpopulations that require further education and management.

The effect of pharmacist-initiated perioperative multidisciplinary pharmaceutical care model and clinical pathway on pain management in patients undergoing orthopedic surgery: a before-after study

BACKGROUND

Poor pain control is common in perioperative orthopedic surgeries. However, there is a lack of exploration of the clinical pharmacy practice model for this population.

AIM

To construct a perioperative pharmaceutical care model and clinical pathway for patients undergoing orthopedic surgeries and assess their impact on pain management.

METHOD

This historical before-and-after study was conducted in the Department of Orthopedics of a tertiary hospital in Guangdong Province, China. The control group was surgical patients who received routine diagnosis and treatment. The intervention group received pain management from a multidisciplinary team based on a pharmacist-initiated pharmaceutical care practice model and clinical pathways for medication management. The primary outcome measures were postoperative pain at rest (PAR) and movement-evoked pain (MEP) scores, number of breakthrough pains, and length of hospital stay.

RESULTS

A total of 320 orthopedic surgery patients were included. Among patients with expected moderate or severe postoperative pain (82.5%), significantly lower PAR and MEP scores were observed in the intervention group 24 h after surgeries compared to the control group (p < 0.05). Compared to the control group, hospital stay in the intervention group was shortened by 2.3 days (p < 0.001). However, there were no significant differences in the control of breakthrough pain and the incidence of adverse drug reactions (p > 0.05).

CONCLUSION

Multidisciplinary perioperative pain management practice models and clinical pathways initiated by pharmacists could improve outcome indicators related to pain management and support the role and value of pharmacists.

Implementation of Daily Pharmacy Student New Medication Education During Hospitalization to Improve Patient Satisfaction

Introduction: Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. Methods: This was a quasi-experimental study. Four Doctor of Pharmacy students were assigned 1 medicine inpatient unit to provide education on new medications during the study period, June to September. The primary endpoint was the change in HCAHPS scores for the medication communication domain composite for the intervention unit and a similar control unit that was not receiving the intervention from the pre-intervention to the intervention periods. Results: A total of 124 patients were educated during the intervention period, with an average age of 65 and 2.2 new medications. Average HCAHPS scores for the medication communication domain for the intervention unit increased from 68% pre-intervention to 91% during the intervention (P = .389) while the control unit remained unchanged at 78% both pre- and during the intervention (P = .13). Conclusion: An increase in the medication communication HCAHPS score for the intervention unit was observed, while the control unit remained stable. This study has the potential to drive change by implementing pharmacy students throughout inpatient units to educate patients on new medications thereby improving patient satisfaction.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.