title: Development and evaluation of a multidisciplinary controlled substances committee within a patient-centered medical home.
abstract: OBJECTIVE
  To present the development of a multidisciplinary controlled substances committee and describe its effectiveness in relation to prescribers' acceptance of committee recommendations, the number of premature deaths associated with controlled substances, and prescribers' need for education on controlled substances.
  
  
  METHODS
  A patient-centered medical home and accountable care organization in Maine that serves more than 60,000 patients across a large rural area, 70% of whom are classified as lower income.
  
  
  METHODS
  A multidisciplinary group of prescribers and PharmD residents created a committee to influence organizational culture regarding controlled substances. The Controlled Substances Initiative Committee (CSIC) updated institutional policies, developed provider education, and made personalized patient recommendations to prescribers.
  
  
  METHODS
  The primary outcome was average change in daily morphine equivalent dose (MED) in patients for whom CSIC recommended a dose reduction to the patient's prescriber. Secondary outcomes included the proportion of patients who died of a known overdose or suspected drug-related death during 2012-2013 or 2013-2014. In addition, prescriber beliefs about controlled substances were measured via a needs assessment.
  
  
  RESULTS
  The average daily MED for patients whom CSIC recommended dose reduction was lower after 3 months compared with at baseline (175.5 ± 344.3 mg vs. 292.7 ± 466.5 mg; P <0.05). The proportion of patients who died of a known overdose did not differ between 2012-2013 and 2013-2014 (11.8% vs. 11.1%; P = 1.00). However, a greater number of patients had a suspected drug-related death during 2013-2014 compared with during 2012-2013 (0% vs. 27.3%; P = 0.05).
  
  
  CONCLUSIONS
  A multidisciplinary controlled substances committee may improve patient safety and outcomes by offering prescriber support and helping alter prescribing culture.
authors.affiliation: College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL; At time of research, Postgraduate Year (PGY)1 Pharmacy Resident, Penobscot Community Health Care, Bangor, ME. Electronic address: sgernant@nova.edu.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Gernant
authors.affiliation: Clinical Pharmacy Services, Commonwealth Medicine, Boston, MA; At time of research, PGY1 Pharmacy Resident, Penobscot Community Health Care, Bangor, ME.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastien
authors.affiliation: Department of Pharmacy, Maine Medical Center, Portland, ME; At time of research, PGY1 Pharmacy Resident, Penobscot Community Health Care, Bangor, ME.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lai
mesh_terms: D060866:Accountable Care Organizations; D000328:Adult; D026683:Advisory Committees / Q000458:organization & administration*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001291:Attitude of Health Personnel; D002423:Cause of Death; D003157:Community Pharmacy Services / Q000458:organization & administration*; D061891:Controlled Substances / Q000008:administration & dosage* / Q000009:adverse effects; D003695:Delivery of Health Care / Q000458:organization & administration*; D062787:Drug Overdose / Q000401:mortality / Q000517:prevention & control; D011307:Drug Prescriptions; D004502:Education, Medical, Continuing; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D008281:Maine; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D015279:Organizational Culture; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D024382:Professional Role; D015397:Program Evaluation; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*
chemical_list: D000701:Analgesics, Opioid; D061891:Controlled Substances; D009020:Morphine