A Cluster-randomized Trial of Modifying Electronic Health Record Defaults to Reduce the Prescribed Quantity of Opioid Analgesics in Primary Care and Emergency Department Settings
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Acute Pain
- Sponsor
- Montefiore Medical Center
- Enrollment
- 15000
- Primary Endpoint
- Initial prescription <= 10 pills (y/n)
- Status
- Completed
- Last Updated
- 7 years ago
Overview
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).
Investigators
Marcus Bachhuber
Assistant Professor
Montefiore Medical Center
Eligibility Criteria
Inclusion Criteria
- •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
Exclusion Criteria
- •Cancer diagnosis code within the past 1 year
Outcomes
Primary Outcomes
Initial prescription <= 10 pills (y/n)
Time Frame: Through study completion (18 months)
Extracted from the electronic medical record
Secondary Outcomes
- Initial prescription number of pills(Through study completion (18 months))
- Initial prescription morphine milligram equivalents(Through study completion (18 months))
- Total morphine milligram equivalents prescribed, including re-orders(Within 30 days after the initial prescription)
- Opioid analgesic re-order (y/n)(Within 30 days after the initial prescription)
- Hospitalizations(Within 30 days after the initial prescription)
- Outpatient visits(Within 30 days after the initial prescription)
- Total opioid analgesic pills prescribed, including re-orders(Within 30 days after the initial prescription)
- Emergency department visits(Within 30 days after the initial prescription)