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Background:
A 58-year old male sustained a low back injury during the course of his employment. In the years following the injury, the injured party’s pain was never adequately managed. Aside from the injury related pain, he also developed other chronic illnesses (gastroesophageal reflux disease, diabetes, anxiety, and hypertension) in the time since his injury. There was no clear indication that his other medical conditions were determined to be causally related to the injury.
Intervention:
A comprehensive review of the injured party’s medical records and prescription history by a clinical pharmacist revealed more than three physicians prescribing medications and a number of issues relating to the injured party’s chronic pain management. In addition to duplications of therapy from the treating prescriber, other duplications of therapy were also identified between two separate prescribers. A significant duplication of therapy included the use of an oral long-acting narcotic in addition to an intrathecal morphine pain pump. The review also revealed multiple medications which were inappropriate for long-term use, as well as several medications being used which appeared to be unrelated to the industrial accident.
Results:
Therapy recommendations by the clinical pharmacist reduced the number of medications from thirteen to three, by either discontinuing the medication altogether or by discontinuing compensation for the medication (if unrelated to the injury). Following a physician review and peer-to-peer contact, the primary treating physician agreed to:
- Taper and discontinue the oral long-acting narcotic since it was determined that the intrathecal pain pump containing morphine was still in place
- Taper and discontinue medications which were inappropriate for long-term use
- Replace one short-acting narcotic containing acetaminophen (APAP) to one without acetaminophen to reduce potential liver damage from chronic APAP use
- Contact another physician who was prescribing a similar medication in order to streamline therapy, eliminate duplicate therapy, and minimize potential adverse effects
- Prescribe several drugs for non-compensable conditions under the injured party’s private insurance
Potential Savings:
Current annual prescription costs: $20,520
Annual prescription costs following therapy modifications: $4,212
Potential savings: $16,308/year
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