Implementation and Evaluation of Clinic-based Medication Disposal Procedures to Reduce Unwanted and Unused Controlled Substances in Homes
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,159
- 试验地点
- 2
- 主要终点
- Disposal of unused opioid following new opioid prescription
研究概览
简要总结
Evidence from recent trials primarily in the post-surgical patient population prescribed opioids for acute pain suggest patients more often properly dispose of unused opioids if instructed by a healthcare professional, if provided education on proper storage and disposal, and provided a physical medication disposal product (e.g. mail back bags). It is not clear how this evidence applied to patients in primary care will be readily adopted and sustained by practices and if the effectiveness will be comparable to that seen in other more controlled studies, largely limited to the surgical population. The objective of this trial is to evaluate a multifaceted program for safe medication disposal in primary care. Interventions include real-time best practice reminders to providers, educational materials mailed to patients, disposal mail-back bags supplied to patients and reminder phone calls. Proper medication disposal after 30 days following order will be assessed by telephone survey.
Our aims are to:
- Evaluate a targeted intervention on patient's newly prescribed opioids within primary care.
- Determine factors that influence patient action to remove unused opioid medications from the home.
详细描述
Prospective studies affirm that education and advice from providers to dispose of unused medications modestly improves medication disposal rates. Two recently published randomized controlled trials demonstrate improved disposal rates when a system for medication disposal, namely a medication disposal bag (e.g. return envelope or activated charcoal) were supplied to patients or caregivers. The impact of education and physical disposal mechanism inferred a greater magnitude of effect than education alone.
Research Design The investigators will use a cluster-randomized stepped-wedge design, using clinics as clusters (i.e., all clinics participate in all arms, but not all at the same time) to compare two main interventions (education only vs. education + mail-back bag). In addition, the investigators will randomize patients in both intervention arms to receive or not to receive an added telephone reminder call through interactive voice response (IVR). The primary outcome of the study, medication disposal actions taken by the patient, will be assessed by a telephone survey.
Study Population The investigators will enroll patients newly prescribed an opioid medication within one of the participating clinics. For patients younger than 18 years old, the investigators will follow clinic procedures for the engagement of parents or guardians; the investigators anticipate that management of medications in this population is largely handled by the guardian or parent and therefore these patients are of key interest when studying proper medication storage and disposal.
Interventions
(1) baseline; (2) education at the clinic level; (3) educational materials mailed to the patient's home; (4) mail back bags mailed to patient's homes and (5) IVR reminder calls
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
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Any patient receiving a new opioid prescription in a face-to-face or telehealth encounter in select Community Medicine Service Line practices.
- •"New opioid prescription" is defined as a prescription for an opioid medication, Categories II-V (not anti-tussive) to a patient who has no opioid on current medication profile and no opioid prescriptions in the previous 3 months.
- •Preferred language, as documented in the electronic health record (EHR), is English.
- •Providers in participating primary care practices who receive the Best Practice Alert (BPA) for eligible patients.
排除标准
- 未提供
结局指标
主要结局
Disposal of unused opioid following new opioid prescription
时间窗: 30-45 days post new opioid prescription
Proportion of patients with unused opioid medication who dispose opioid as assessed by telephone survey
次要结局
- Second prescription of opioid within 60 days post new opioid prescription(60 days post new opioid prescription)
- Patient satisfaction with medication mail back disposal bag(30-45 days post new opioid prescription)