A Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing

Not Applicable

Completed

• Conditions: Acute Pain
• Interventions: Behavioral: Individual audit feedback; Behavioral: Peer comparison feedback

• Registration Number: NCT03825549
• Lead Sponsor: University of Pennsylvania

Brief Summary

In this study, the investigators will evaluate the effect of a health system initiative aiming to change clinician opioid prescribing behaviors using two behavioral economic interventions - individual audit feedback and peer comparison feedback of clinicians.

Detailed Description

Opioid-related abuse and overdose represent a growing national epidemic in the United States. Clinician practice patterns play an important role: opioid prescriptions impact the likelihood that patients will misuse or become dependent on these medications, with longer prescriptions leading to greater sustained use. In this study, we will evaluate a Sutter Health System quality improvement initiative using monthly individual audit feedback and/or monthly peer comparison feedback to clinicians to change opioid prescribing patterns. In partnership with Sutter Health System, this will be conducted using randomization to evaluate its effect. We will also conduct a process evaluation to understand factors associated with better or worse performance at the clinician level.

Study Timeline

• Study First Submitted: 2019-01-17
• Study First Submitted QC: 2019-01-29
• Study First Posted: 2019-01-31
• Study Start: 2019-09-03
• Status Verified: 2020-03
• Primary Completion: 2020-03-02
• Study Completion: 2020-03-02
• Last Update Submitted: 2020-03-04
• Last Update Posted: 2020-03-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 452

Inclusion Criteria

• Clinicians

  1. Practiced primarily at participating emergency department or urgent care center

• Patients

  1. Presented to a participating emergency department or urgent care center during the study period
  2. Discharged to home from the visit

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Exclusion Criteria

• Clinicians

  1. Saw less than 100 patients in the prior year
  2. Practiced primarily at another site that is not in the main trial
  3. Did not practice at Sutter Health in the prior 90 days

• Patients

  1. Currently pregnant

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Individual Audit	Individual audit feedback	Clinicians will receive individual audit feedback informing them of their performance.
Peer Comparison	Peer comparison feedback	Clinicians will receive peer comparison feedback informing them of how their performance compares to their peers.
Individual Audit and Peer Comparison	Individual audit feedback	Clinicians will receive individual audit feedback informing them of their performance and peer comparison feedback informing them of how their performance compares to their peers.
Individual Audit and Peer Comparison	Peer comparison feedback	Clinicians will receive individual audit feedback informing them of their performance and peer comparison feedback informing them of how their performance compares to their peers.

Primary Outcome Measures

Name	Time	Method
Change in the mean number of pills per opioid prescription	Six months	The primary outcome is the change in the mean number of pills prescribed per opioid prescription from baseline to the intervention period.

Secondary Outcome Measures

Name	Time	Method
Change in proportion of patient visits with an opioid prescription	Six months	The secondary outcome is the change in proportion of patient visits in which an opioid is prescribed from baseline to the intervention period.

Trial Locations

Locations (1)

Sutter Heath; 🇺🇸 Walnut Creek, California, United States