Abstract

Objectives: To describe the roles of pharmacists in a chronic pain management clinic (PMC) and to discuss the impact of a pharmacist-developed protocol on monitoring for rate-corrected QT interval prolongation with methadone when used for chronic noncancer pain.Setting: An academic family medicine department with an affiliated PMC in which pharmacists practice, from 2005 to 2008.Practice description: Pharmacy services in the PMC included taking medication histories and reconciling the medication record at each visit, assessing the efficacy and safety of drug therapy, making therapeutic recommendations to the two PMC physicians, and counseling patients on their drug regimens. These services were provided by faculty pharmacists and by student pharmacists completing their advanced pharmacy practice experiences at the site.Practice innovation: Based on a need identified in a medication use evaluation performed by the pharmacists, a protocol was developed with the objective of increasing the rates of cardiac monitoring in high-risk patients prescribed methadone in all of the department's clinics.Main outcome measure: Rates of electrocardiogram (ECG) monitoring pre- and postprotocol were compared to determine the impact of the protocol.Results: A 19% absolute (136% relative) increase occurred in the proportion of high-risk patients who had an ECG performed (P = 0.02). The proportion of high-risk patients from the PMC who had an ECG increased by 20% (absolute; 27% relative; P = 0.005), with no significant change in the other clinics.Conclusion: The implementation of a pharmacist-developed protocol resulted in improvements in monitoring practices. The improvement was most pronounced in the PMC, which uses pharmacists in the patient care process. This suggests that the involvement of pharmacists in the application of the protocol may be more important than the existence of a protocol.