The future of pain pharmacy: driven by need

Figures & data

Figure 1 Comparison of disease prevalence and specialty training programs.

Notes: (A) Data obtained from 2008 reported in 2011 IOM report. Data from American Society of Health-System Pharmacists,²⁹ Institute of Medicine,¹ American Diabetes Association,³⁵ Centers for Disease Control and Prevention,³⁶ and American Cancer Society³⁷ (B) Data from 2015 National Matching Statistics.⁷
Abbreviations: IOM, Institute of Medicine; PGY-2, postgraduate year two.

Table 1 PGY-2 Pharmacy Pain and Palliative Care Residency Programsa

VA Central Arkansas		VA N Florida/ S Georgia		VA West Palm Beach, FL		OSU CoP/HospiScript		University of Maryland		VA Albany, NY
Duration	Core rotations	Time	Core rotations	Time	Core rotations	Time	Core rotations	Time	Core rotations	Time	Longitudinal
1 mo	Pall Care inpatient Svc	4 mo	Inpatient hospice	2 mo	Chronic pain	1 mo	Hospice inpatient	1 mo	Home-based hospice	9 mo	Nephrology
1 mo	Pall Care outpatient Svc	1 mo	Inpatient pain consults	2 mo	Hospice and Pall Care	1 mo	Hospice outpatient	1 mo	Inpatient acute pain	9 mo	Neurology
1 mo	Pall Care consult Svc	1 mo	Outpatient hospice	1 mo	PMR and pain procedures	1 mo	PC inpatient oncology	1 mo	Inpatient Pall Care	9 mo	Rheumatology
2 mo	Pall Care	1 mo	Substance abuse	1 mo	Substance abuse	1 mo	PC inpatient internal med	1 mo	Inpatient hospice	9 mo	HIV/ID
1 mo	Home hospice	1 mo	Hematology/ oncology	1 mo	Inpatient acute pain	1 mo	PC outpatient	1 mo	Inpatient cancer pain	9 mo	Suboxone clinic
2 mo	Acute pain SICU	1 mo	Interventional/ outpatient pain	1 mo	Hematology/oncology	1 mo	Acute/interventional pain Mgmt	1 mo	Interventional/pain clinic	9 mo	Pall Care
		1 mo	PC pain/ UF Health Pall Care			1 mo	Drug information
Duration	Elective rotations	Time	Elective rotations	Time	Elective rotations	Time	Elective rotations	Time	Elective rotations	Time	Elective rotations
1 mo	Chronic pain – WPB	1 mo	Psychiatry	1 mo	Psychiatry	1 mo	Pediatric hospice and PC	1 mo	Oncology	1 mo	Addiction/substance abuse
1 mo	Hematology/ oncology	1 mo	Neurology	1 mo	Home based and primary care	1 mo	Managed care	1 mo	ED or critical care	1 mo	ED
1 mo	Psychiatry/ substance abuse	1 mo	Rheumatology	1 mo	Neurology or cardiology	1 mo	Administration/advocacy	1 mo	Internal med	1 mo	Acute inpatient pain
		1 mo	ICU/ER	2 wks	TH hosp or rheumatology			1 mo	Psych or substance abuse
	Longitudinal		Longitudinal		Longitudinal		Longitudinal		Longitudinal	Time	Core rotation
N/A	IMPACT – chronic pain	N/A	Pain and UDS E-Consults	8 h/ wk	Hospice/Pall Care	16 h/ wk	Hospice consulting and PBM	4 h/ wk	Chronic pain	2 mo	Chronic pain clinic, PACT
		N/A	Pall Care consult	8 h/ wk	Chronic pain
	Primary setting		Primary setting		Primary setting		Primary setting		Primary setting		Primary setting
	Pall Care		Pall Care		Chronic pain and Pall Care		Hospice consulting/Pall Care		Pall Care		Chronic pain
	Inpatient/ outpatient		Inpatient/ outpatient		Inpatient/ outpatient		Inpatient/outpatient		Inpatient/ outpatient		Inpatient/ outpatient
	Evenly split		Evenly split		Evenly split		Evenly split		Inpatient		Outpatient
Lakeland Regional Health		Johns Hopkins		University of Washington		Summa Health/Akron City		UC Davis Medical Center		Developing programs
Duration	Core rotations	Time	Core rotations	Time	Core rotations	Time	Core rotations	Time	Core rotations	Precandidate status
4 mo	Acute and chronic pain	2 mo	Pain and Pall Care	1 mo	Acute pain	1 mo	Pharmacy operations	3 mo	Inpatient pain	Dana-Farber Cancer Institute
1 mo	Emergency dept	1 mo	Hospice and Pall Care	1 mo	Inpatient chronic pain	1 mo	Hospice operations	1 mo	Inpatient Pall Care	Boston, MA
1 mo	Oncology	2 mo	Neurosciences	1 mo	Inpatient Pall Care	1 mo	Inpatient acute Pall Care	1 mo	Home hospice
1 mo	Critical care	1 mo	Interventional pain	1 mo	Home hospice	1 mo	Inpatient Pall Care Consult	1 mo	Acute pain service	University of Iowa College of Pharmacy
1 mo	Pall Care/hospice	1 mo	Acute pain service	1 mo	Post-surgical orthopedic	1 mo	Gen psychiatry	2 mo	Interventional/pain clinic	Iowa City, IA
1 mo	Psychiatry			1 mo	Outpatient chronic pain	1 mo	Chronic pain	1 mo	Pediatric pain
								1 mo	HIV/AIDS pain
Duration	Elective rotations	Time	Elective rotations	Time	Elective rotations	Time	Elective rotations	Time	Elective rotations
2 wk	Addiction recovery	1 mo	Pediatric pain	1 mo	ED or critical care	1 mo	Hematology/oncology	1 mo	Neuro/ortho surgery
2 wk	Headache clinic	1 mo	Inpatient pain and Pall Care	1 mo	Oncology	1 mo	ED or critical care	1 mo	Critical care
2 wk	Interventional medicine			1 mo	Addiction/substance abuse	1 mo	Geriatrics/Pall Care LTC	1 mo	Psychosomatic medicine
1 mo	Trauma			1 mo	Headache or pediatrics	1 mo	Substance abuse	1 mo	Gynecological surgery
	Longitudinal		Longitudinal		Longitudinal		Longitudinal		Longitudinal
1 y	Drug information	8 h/ wk	Pain and Pall Care	4 h/ wk	Outpatient chronic pain	4 h/ wk	Hospice IDT/Pall Care clinic	N/A	Cancer/pediatric
	Primary setting		Primary setting		Primary setting		Primary setting		Primary setting
	Acute pain		Acute pain		Acute pain/hospice		Pall Care		Acute pain
	Inpatient/ outpatient		Inpatient/ outpatient		Inpatient/outpatient		Inpatient/outpatient		Inpatient/outpatient
	Inpatient		Inpatient		Inpatient		Inpatient		Inpatient

Notes:

a Results of a survey of the eleven currently accredited PGY-2 residency programs in the US. Through discussions with current residents, residency program directors, and published residency information, specific information regarding core rotations, elective experiences, longitudinal requirements, practice settings, and inpatient vs outpatient focus were ascertained and are summarized in this table.

Abbreviations: VA, Veterans Affairs; OSU, Ohio State University; Pall Care, palliative care; Svc, service; Longitudinal, longitudinal rotation; WPB, West Palm Beach; Hem/Onc, hematology/oncology; Exp, experience; CoP, College of Pharmacy; LTC, long-term care; IDT, interdisciplinary team; TH, Trustbridge Health; ED, emergency department; PMR, physical medicine and rehabilitation; PC, primary care; UDS, urine drug screen; E-Consult, electronic consult; ICU, intensive care unit; ER, emergency room; Mgmt, management; h, hours; mo, months; wk, weeks; y, year; N/A, not applicable; ID, infectious disease; PBM, pharmacy benefits management; PACT, primary aligned care team; UF, University of Florida.

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