Electronic Defaults to Reduce Opioid Prescribing in Emergency Department and Primary Care Settings
- Conditions
- Acute Pain
- Interventions
- Other: Change in electronic health record default for new opioid analgesic prescriptions
- Registration Number
- NCT03003832
- Lead Sponsor
- Montefiore Medical Center
- Brief Summary
The goal of this research is to investigate the impact of changing opioid analgesic prescribing defaults on the quantity of opioids prescribed for acute non-cancer pain in adult primary care and emergency department settings. We will change prescribing defaults for select short-acting opioid analgesics including immediate release oxycodone and hydrocodone as well as codeine and tramadol, including their co-formulations with acetaminophen. In a cluster-randomized trial of matched pairs of Montefiore Medical Center clinical sites, stratified by specialty and teaching status, we will evaluate the impact of this intervention on patient-level outcomes using 18 months of data (6 months pre-intervention and 12 months post-intervention).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 15000
- Primary care clinic (internal medicine, family medicine, or urgent care) or emergency department within Montefiore Medical Center
Patient Inclusion Criteria:
- Received a new opioid analgesic prescription, defined as no opioid analgesic prescription in the preceding 6 months
Patient
- Cancer diagnosis code within the past 1 year
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Change in electronic health record default for new opioid analgesic prescriptions The intervention condition consists of a change to the electronic health record so that new opioid analgesic prescriptions automatically default to 10 pills (i.e., the "quantity dispensed" field is pre-populated). This value is modifiable by providers who can tailor the prescription based on clinical factors.
- Primary Outcome Measures
Name Time Method Initial prescription <= 10 pills (y/n) Through study completion (18 months) Extracted from the electronic medical record
- Secondary Outcome Measures
Name Time Method Initial prescription number of pills Through study completion (18 months) Extracted from the electronic medical record
Initial prescription morphine milligram equivalents Through study completion (18 months) Extracted from the electronic medical record
Total morphine milligram equivalents prescribed, including re-orders Within 30 days after the initial prescription Extracted from the electronic medical record
Opioid analgesic re-order (y/n) Within 30 days after the initial prescription Extracted from the electronic medical record
Hospitalizations Within 30 days after the initial prescription Extracted from the electronic medical record
Outpatient visits Within 30 days after the initial prescription Extracted from the electronic medical record
Total opioid analgesic pills prescribed, including re-orders Within 30 days after the initial prescription Extracted from the electronic medical record
Emergency department visits Within 30 days after the initial prescription Extracted from the electronic medical record