None listed
Conditions
Brief summary
In Australia between 2015 and 2019, there were 2731 unintentional deaths due to prescription opioids1. Many consumers are unaware of how to use opioids safely and that opioids can cause addiction and harm. Many consumers are not receiving adequate instructions about opioids from doctors. When instructions are poor, consumers are less likely to receive the benefits of opioid medications and more likely to become opioid dependent. Hospital settings such as the emergency department (“ED”) and the surgical outpatient department (“OPD”) are key risk areas for initiating treatment with opioids for acute pain after injury or surgery. Approximately 16% of patients who received their first opioid medication from a WA hospital between 2014 and 2015 were still taking opioids one year later. The OPIOIDS Trial will be run as a multi-site intervention trial to assess the efficacy of personalised, mobile-accessible patient instructions for opioid medications at discharge from the ED and surgical OPD with patients and doctors.
Interventions
The intervention in this study is the implementation of the What the Doctor Said system (“WTDS system”). The system is web-based system and functions with diagnosis "templates" which doctors edit to send personalised discharge instructions to their patient’s mobile phone.
The patient discharge instructions include information such as opioid medication dosage, duration and side effects details, further relevant medication resources, follow up appointment details as well as symptoms and signs to
The intervention in this study is the implementation of the What the Doctor Said system (“WTDS system”). The system is web-based system and functions with diagnosis "templates" which doctors edit to send personalised discharge instructions to their patient’s mobile phone. The patient discharge instructions include information such as opioid medication dosage, duration and side effects details, further relevant medication resources, follow up appointment details as well as symptoms and signs to watch out for. After seeing the patient, doctors working in the ED or surgical outpatient department setting use a desktop computer to create discharge instructions. These instructions are then sent via an embedded link in a text message to the patient. The patient opens the instructions on their phone before leaving the ED or surgical outpatient department setting. The instructions take no longer than 5 minutes for a patient to read. The study will be implemented in three phases, Pre phase, Implementation phase and Post phase. Pre phase The Pre phase will run over 4 weeks. In the ED settings the Pre phase will commence in March 2023 and in the surgical outpatient settings the Pre Phase will commence in August 2023. During this time, patients will receive 'usual' advice for discharge instructions (commonly this is verbal advice but in some instances may be accompanied by written advice). a) Patients Patients will be asked to complete 2 short surveys on their experience of receiving discharge instructions for opioids. Survey 1 will be sent at 24 to 48 hours post visit to the ED or surgical outpatient department. Survey 2 will be sent 5 to 7 days after their visit. Both surveys will take no longer than 10 minutes to complete in total. b) Doctors i) Surveys Doctors will be asked to complete a short survey on their experience giving discharge instructions for opioids in the ED or surgical outpatient department. The survey will take no longer than 5 minutes to complete. ii) Usability testing (Pre phase only) 8 to 10 doctors will be asked by senior clinical staff if they are prepared to volunteer to participate in usability testing of the doctor desktop interface of the What the Doctor Said system. This session will take approximately 40 minutes to complete and will take place in a room or area of the ED or outpatient department where a standard desktop computer is available. The session will consist of three parts: - questions around the doctor participant's experience providing patient discharge instructions for opioids - direct observation of the doctor participant using the desktop interface of the WTDS system to create instructions for a patient based on a fictional scenario - asking the doctor participant to rate the usability of the desktop interface using the System Usability Scale ("SUS"), a widely used Likert-type 10 question survey measuring a user’s satisfaction where responses are converted into an overall usability score out of 100. Intervention phase This phase will run over 8 weeks and will run directly after the Pre phase. No recruiting of participants will occur during this phase. During this phase the WTDS system will be made accessible to credentialed doctors working in the ED and surgical outpatients settings at East Metropolitan Health. During this phase, patients who see a credentialed doctor working in the ED and surgical outpatients settings will receive personalised discharge instructions for opioids on their phone via the WTDS system and will also be provided with a printed copy of these instructions. Post-phase This phase will run over 4 weeks and will run directly after the Implementation phase. a) Patients Patients will be asked to complete 2 short surveys on their experience of receiving discharge instructions for opioids. Survey 1 will be sent at 24 to 48 hours post visit to the ED or surgical outpatient department. Survey 2 will be sent 5 to 7 days after their visit. Both surveys will take no longer than 10 minutes to complete in total. b) Doctors Doctors will be asked to complete a short survey on their experience giving discharge instructions for opioids in the ED or surgical outpatient department. The surveys will take no longer than 5 minutes to complete.
Sponsors
What the Doctor Said Pty Ltd
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
a) Patient participants • aged 18 years and over • acute musculoskeletal complaints not requiring admissions (strains, sprains, extremity fractures not requiring operative management, gouty arthritis) • visceral complaints not requiring admission (abdominal pain, renal colic, gynaecological pain with negative pregnancy test, or biliary colic) • post-operative pain associated with common general acute orthopaedic, plastics or surgical procedures (forearm fracture, wrist fracture, clavicle fracture, rib fracture, finger or thumb fracture, skin laceration, burn injury, cholecystectomy, appendicectomy) b) Doctor participants • physician currently employed or on rotation as a permanent staff member in the ED or surgical OPD • no prior knowledge of the What the Doctor Said system for providing opioid instructions
Exclusion criteria
a) Patient participants • unwilling or unable to comply with follow up • non-English speaking • chronic pain syndrome • clinical suspicion of drug-seeking behaviour • patients who have undergone complex surgical procedures b) Doctor participants • prior participation in the pilot study at Sir Charles Gairdner Hospital or involvement with interface usability testing of the WTDS system
Outcome results
None listed