A Cluster-randomized Trial of Modifying Electronic Health Record Defaults to Reduce the Prescribed Quantity of Opioid Analgesics in Dentistry Practices
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Montefiore Medical Center
- Enrollment
- 10,000
- Primary Endpoint
- Initial prescription number of pills to dispense
Study 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 dentistry 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 three Montefiore Medical Center dentistry sites, 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).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Clinical Site Inclusion Criteria:
- •Dentistry clinic 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
- Not provided
Arms & Interventions
10-pill default
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.
Intervention: Change in electronic health record default for new opioid analgesic prescriptions (Other)
5-pill default
New opioid analgesic prescriptions will automatically default to 5 pills.
Intervention: Change in electronic health record default for new opioid analgesic prescriptions (Other)
Standard of care
The control condition will be the usual electronic health record interface. The default number of pills varies by medication, most medications currently have either a blank default or a default of 30 pills.
Outcomes
Primary Outcomes
Initial prescription number of pills to dispense
Time Frame: Through study completion (18 months)
From the electronic health record
Secondary Outcomes
- Initial prescription morphine milligram equivalents to dispense(Through study completion (18 months))
- Hospitalizations(Within 30 days after the initial prescription)
- Opioid analgesic reorder (y/n)(Within 30 days after the initial prescription)
- Total opioid analgesic pills to dispense, including re-orders(Within 30 days after the initial prescription)
- Outpatient visits(Within 30 days after the index prescription)
- Total morphine milligram equivalents to dispense, including re-orders(Within 30 days after the initial prescription)
- Emergency department visits(Within 30 days after the initial prescription)
Investigators
Marcus Bachhuber
Assistant Professor
Montefiore Medical Center