Impact Evaluation of the Therapeutic Initiative's Prescribing Portrait and Therapeutics Letter on Opioid Use by Dentists for Dental Pain
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 3,498
- 试验地点
- 1
- 主要终点
- The number of opioid prescriptions per dentist
研究概览
简要总结
The aim of this study is to estimate the impact of providing personalized prescribing data and educational materials on opioid prescribing to dentists in British Columbia, Canada.
The main research questions are:
- What is the impact of an intervention on the use of opioids for dental pain? The intervention includes a personalized prescribing report (a "Portrait"), brief educational summary, and patient education materials; and
- Does the impact of the intervention increase when dentists are also invited to attend facilitated audit-and-feedback group sessions and to develop a practice improvement plan? Using administrative health data, the prescribing of those in different combinations of materials in the Early Group will be compared to those in the Delayed Group to estimate the impact of the materials on prescribing by the dentists.
详细描述
Audit and feedback is a well-established strategy for improving the quality of care in primary healthcare settings. It involves the systematic collection and analysis of healthcare data, followed by the provision of information to healthcare providers to improve the quality of care.
Medical overprescribing of opioids significantly contributed to overdose deaths from 1995-2015. Although illicit synthetic opioids now dominate the overdose crisis, prescription opioids remain implicated in 22% of overdoses and 2% of fatal overdoses in British Columbia (BC). Dentists play an important role in opioid exposure: opioids may be prescribed in up to half of dental procedures, and general dentists account for 13% of all opioid prescriptions in BC.
Based in British Columbia, Canada, the Therapeutics Initiative's Portrait program provides clinicians with individualized prescribing data compared with their peers, paired with evidence-based messaging, and a concise statement summarizing the desired change in prescribing behavior. The Portrait program implements a series of pragmatic trials to improve prescribing where clinicians are randomized into an early intervention and a delayed control group.
This study examines the impact of prescribing Portraits on opioid prescribing by dentists in British Columbia. The Portrait title is "Do you manage dental pain with opioids?" and is accompanied by a Therapeutics Letter entitled "Pharmacological management of dental pain and inflammation."
3,498 active dentists in BC will be randomized into 3 Groups/Arms (n=1166 in each Group) for this intention-to-treat analysis.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Health Services Research
- 盲法
- Single (Participant)
盲法说明
Dentists will not be masked to their group allocation but will not be aware of the trial arm variations being evaluated or the analytical approach. The statistical analysis plan is being developed by an evaluation committee who are masked to the trial arm allocation.
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Dentists will be eligible to receive an individual prescribing Portrait if they meet all of the following criteria:
- •Registered with the British Columbia Medical Services Plan (MSP) as being in active practice;
- •Have a valid mailing address in British Columbia; and
- •Issued ≥10 prescriptions dispensed at community pharmacies between January 5, 2025 and January 5, 2026, as identified in PharmaNet claims data.
- •Patients will be eligible for inclusion if they meet all of the following criteria:
- •Received an opioid prescription from an eligible dentist during the study period (January 6, 2026 to January 6, 2027);
- •The opioid prescription was issued by a dentist; and
- •Were continuously enrolled in the British Columbia Medical Services Plan (MSP) during the 12 months prior to the opioid prescription.
排除标准
- •Patients will be excluded if they meet any of the following criteria:
- •Had a medication dispensed under Plan P in the 12 months prior to the opioid prescription; or
- •Filled a prescription for opioid agonist therapy (OAT) within 180 days prior to the opioid prescription.
结局指标
主要结局
The number of opioid prescriptions per dentist
时间窗: From baseline to 12 months post interventions. The baseline is the 12-month period before the date when the prescriber is mailed the intervention bundle.
The primary outcome is the change from baseline in the number of opioid prescriptions per dentist. The primary measures of effect will be absolute differences between trial arms, differences in prescribing trends over time, and difference-in-differences estimates comparing the intervention period with the pre-intervention period.
Total morphine milligram equivalents (MME) prescribed per dentist
时间窗: From baseline to 12 months post interventions. The baseline is the 12-month period before the date when the prescriber is mailed the intervention bundle.
The primary outcome is the change from baseline in the total morphine milligram equivalents (MME) prescribed per dentist. The primary measures of effect will be absolute differences between trial arms, differences in prescribing trends over time, and difference-in-differences estimates comparing the intervention period with the pre-intervention period.
次要结局
- Rate ratios between trial arms(From baseline to 12 months post intervention. The baseline is the 12-month period before the date when the prescriber is mailed the intervention bundle.)
研究者
Colin Dormuth
Associate Professor
University of British Columbia