SCORxE

What is SCORxE?

The South Carolina College of Pharmacy (SCCP) Academic Detailing Service is officially identified as SCORxE which stands for South Carolina Offering Prescribing Excellence. Our mission is to improve the quality of healthcare in South Carolina through individualized educational outreach to healthcare providers to help with evidence-based prescribing and patient care decisions that consider risk, benefit, and cost-effectiveness in select clinical areas. 

Why Academic Detailing?

The pharmaceutical industry has long used detailing to promote drug products to the medical community. Academic detailing utilizes the effective communications strategies of the pharmaceutical industry, to more effectively promote best evidence for prescribing, screening, and patient education. Clinical consultants meet face-to-face with providers to deliver relevant educational and behavioral key messages through interactive office visits that vary depending on the unique needs of each provider. Academic detailing services exist in multiple states in the US and other countries, including Australia and Canada.

Who Supports SCORxE?

In 2007, SCORxE was created as the first of its kind in South Carolina through a collaborative effort between the SCCP and the South Carolina Department of Health and Human Services (SCDHHS) funded by SCDHHS to provide academic detailing services to physicians who serve Medicaid patients with mental health disorders, HIV/AIDs, or cancer. More recently, SCORxE has been funded through: a collaborative effort between the South Carolina Department of Health and Environmental Control (DHEC) Bureau of Drug Control and the Medical University of South Carolina (MUSC) funded by the Centers for Disease Control (CDC) as part of their Prescription Drug Overdose Prevention for States Program; a collaborative effort between MUSC and the Department of Alcohol and Other Drug Abuse (DAODAS) funded by Substance Abuse and Mental Health Services Administration (SAMHSA); and through a collaborative effort between MUSC and SCDHHS funded by Centers for Medicare and Medicaid Services (CMS) through the tipSC initiative to address gaps in evidence-based care and detect abuse, overuse or inappropriate use.  Currently, funding is provided by SCDHHS.

Timely Information for Providers in South Carolina (tipSC)

 

Clinical Topics

SOS for Safer Opioid Prescribing – 2018

Share educational information with patient and complete the informed consent process prior to initiating a trial of long-term opioids therapy for chronic non-cancer pain
Optimize patient treatment (drug/non-drug) using a multi-dimensional rating scale to assess chronic pain, quality of life, and progress toward functional goals
Screen for appropriate opioid use and the continued need for opioid therapy, including prescription drug monitoring reports (i.e., SCRIPTS reports)

4-page Handout – December 2018 (PDF)

Selected Resources – December 2018 (PDF)

SCRIPTS Tips and Tricks Handout (PDF)

OPIOID Products: Characteristics and Conversion Factors (PDF)

OPIOID Products: Characteristics and Conversion Factors References (PDF)

Patient Provider Agreement (PDF)

Low Literacy Patient Provider Agreement (PDF)

PEG Scale (three-item scale of pain, enjoyment of life, and general activity) (PDF)

Opioid Fast Facts (PDF)

Treatment of Asthma in Pediatrics – 2015

Assess and document initial severity and follow-up control to select optimal medications.
Environmental control includes a smoke-free home and car and avoiding or minimizing exposure to triggers.
Develop a written asthma action plan for patient self-management and provide copies for use at home, school, and daycare.
Instruct patients and parents on the proper use of each of their inhalers

8-page handout – May 2015 (PDF)

8-page handout reference page – May 2015 (PDF)

Management of Major Depressive Disorder in Pediatrics – 2014

8-page Handout – December 2014 (PDF)

Patient Handout (English) (PDF)

Patient Handout (Spanish) (PDF)

Second Generation Antipsychotics (SGAs) in Pediatrics – 2013

Complete a mental health evaluation, including assessment for substance abuse, prior to initiating an antipsychotic or any other psychotropic medication.
Assess the effectiveness of and continued need for antipsychotics on a regular basis.
Routinely monitor for weight gain, metabolic changes, and other antipsychotic medication side effects.
Engage with family, child, and other key people (e.g., other Health care professionals, teachers, caregivers) involved with child.

8-page handout – March 2013 (PDF)

Healthy Sleep Habits – February 2013 (PDF)

Healthy Sleep Habits (Spanish) – February 2013 (PDF)

Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Pediatrics – 2011

Assess input from both home and school before diagnosing ADHD in children and adolescents.
Discuss strengths/weaknesses of pharmacotherapy and behavioral therapy while considering comorbidities to individualize treatment plan.
Have functional and symptomatic improvements included in negotiated treatment goals with parents and teachers.
Do monthly follow-up in early phases of care for each new ADHD patient or new ADHD medication.

Everyday Survival Tips and Behavioral Strategies – March 2012 (PDF)

Promotion of Smoking Cessation – 2010

Question and document tobacco use at every visit.
Understand the challenge to quit and expect relapse.
Identify readiness to quit to best tailor approach to patient.
Treatment is effective and multiple options allow for individualized interventions.
S.C. Tobacco Quitline Fax Referral Form – October 2010

U.S. Department of Health and Human Services – You Can Quit Smoking (English) – September 2008

U.S. Department of Health and Human Services– You Can Quit Smoking (Spanish) – September 2008 (PDF)

Treatment for Bipolar Disorder – 2009

Accurate and timely diagnosis is critical to optimize clinical outcomes.
Return to full psychosocial functioning is the goal of treatment.
Medication is the mainstay of treatment for initial mood stabilization and maintenance.
Screen for substance abuse to increase the chance of clinical improvement.

Mood Disorder Questionnaire – March 2009 (PDF)

Mood Chart – March2009 (PDF)

Treatment of Non-Psychotic Major Depressive Disorder – 2008

Adequate trial of an antidepressant consists of BOTH an adequate dose and duration Rating scales, such as the Patient Health Questionnaire (PHQ-9), are useful to assess symptom severity before initiating medication and at regular intervals to assess patient response. Treat to remission, not just partial response, and inform patients that remission is the goal of treatment. Total duration of treatment should last 9 to12 months for the first episode of depression, and potentially indefinitely for severe or recurrent episodes.

Patient Health Questionnaire (PHQ-9) – October 2007 (PDF)

Treatment of Schizophrenia – 2007

An adequate trial of an antipsychotic consists of BOTH an adequate medication dosage and duration. Use a rating scale to assess symptom severity before initiating medication; then repeat scale at regular intervals to assess patient response and determine if further dose adjustments are needed. Talk with the patient and family about the importance of medication adherence and collaborate to provide symptom relief and minimize side effects.

Rating Scale – October 2007 (PDF) links to PDF Rating Scale.pdf

Evidence Based Practice Reports

Best Practices for the Management of Asthma in Pediatric Primary Care in South Carolina – May 2015

A group of pediatricians, including a pediatric pulmonologist, and clinical pharmacists was created to develop evidence-based content on the management of asthma in pediatric primary care. The National Institutes of Health National Asthma Education and Prevention Program Expert Panel Report-3 2007 was the group’s primary source of data. Additional review of primary literature and clinical practice guidelines offered supplemental information, along with clinical consensus from the SCORxE writing group. 

SCORxE Writing Group (Sarah Ball, Pharm.D., Mike Bowman, M.D., Sandra Garner, Pharm.D., Nancy Hahn, Pharm.D., Sophie Robert, Pharm.D., Francis Rushton, M.D., Elizabeth Weed, Pharm.D., Christopher Wisniewski, Pharm.D.)

Best Practices for the Promotion of Smoking Cessation in South Carolina – November 2010

A group of primary care physicians, pharmacists, and other Health care professionals was created to develop an evidence-based best practices report to focus on promoting smoking cessation in primary care. The May 2008 Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. U.S. Department of Health and Human Services Public Health Service (hereby referred to as PHS Guideline) was the group's primary source of information. Most of the evidence is based on studies of cigarette smoking. In many cases, the PHS Guideline panel believes the results can be generalized to all tobacco users. This report includes additional recommendations from a review of primary literature published since the PHS Guideline was issued. Modifications were made to the PHS Guideline as necessary for the SCORxE project.

SCORxE Writing Group (Sarah Ball, Pharm.D., Leonard Egede, M.D., Nancy Hahn, Pharm.D., Patrick Mauldin, Ph.D., William Moran, M.D., Jean Nappi, Pharm.D., Sophie Robert, Pharm.D.)  

Primary Care Management of ADHD in Childhood – An Overview of the Literature – December 2010

A comprehensive literature review was conducted to create an evidence-based report on the management of Attention-Deficit/Hyperactivity Disorder (ADHD) in pediatric primary care. The literature review and report utilized several clinical practice guidelines published in the United States and England from 2000 through 2009. The report also provides supplemental information from a number of important recent publications. The scope of the review was restricted to the management of ADHD in children and young adolescents.

Original Review (Frank May of the Australian Drug and Therapeutics Information Service) SCORxE Editors (Sarah Ball, Pharm.D., Sophie Robert, Pharm.D., Nancy Hahn, Pharm.D., Elizabeth Weed, Pharm.D.)

Evidence-Based Best Practices

A panel of psychiatrists and five clinical pharmacists from different geographic regions of the state was created to consensually agree on evidence-based best practices for the treatment of selected mental health disorders in South Carolina. The panel recommended detailed treatment algorithms as the core of their best practices. The evidenced-based materials and algorithms developed and implemented in the Texas Medication Algorithm Project (TMAP) were the panel’s primary source of information. Supplemental information included specific recommendations from a review of primary literature and clinical opinion of the SCORxE mental health panel members. Modifications were made (with permission) to the TMAP content and algorithms as necessary for the SCORxE project, based on the panel’s consensus or vote. Panel members listed below co-authored all three best practices reports unless otherwise indicated.

Best Practices for the Treatment of Schizophenia in South Carolina – October 2007 (archived)

Best Practices for the Treatment of Major Depressive Disorder in South Carolina – February 2008 (archived)

Best Practices Report for the Treatment of Bipolar Disorder in South Carolina – May 2009 (archived)