Opioid-sparing pain management Signs and Symptoms
Conditions
Interventions
Current intervention as of 04/08/2023:
Intervention 1: Complex intervention (prescribing portrait and optional academic detailing session).
Intervention 2: Usual care followed by delayed complex inter
Sponsors
Therapeutics Initiative, University of British Columbia
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Current participant inclusion criteria as of 03/09/2021: Physicians: 1. Currently actively treating patients (active prescriber is defined as having prescribed any medications at least 100 times in 2019 to eliminate retired or mostly retired physicians. For the 100 prescriptions, we counted only the number of dispensations recorded in the database without any restriction on patients) 2. Physicians defined as a 'General Practitioner' with a license status of 'Private Practice' according to Medical Services Plan (MSP = BC’s public insurance program) 3. Physicians who have a functioning postal address. Patients: 1. Aged =19 years Previous participant inclusion criteria as of 06/01/2021: 1. Physicians currently treating patients (defined as having prescribed any medications at least 100 times in 2019) 2. Have prescribed at least one opioid during the study period Previous participant inclusion criteria: 1. Physicians currently treating patients (defined as having written at least 25 prescriptions, for any drug, in the preceding 12 months) 2. Have prescribed at least one opioid during the study period
Exclusion criteria
Exclusion criteria: Current participant exclusion criteria as of 03/09/2021: Physicians: 1. Currently residing outside of BC 2. Prescribed less than one opioid analgesic to an opioid-naïve patient during the study period 3. Opted out of the Portrait program or recorded as retired or deceased in the database Exclusion criteria - Participating patients: 1. Have been dispensed any opioids or opioid agonist therapies in the last six months (i.e., during the washout period) 2. Have been on Plan B (long term care) or Plan P (palliative care) at any time during the washout period or study period (as a proxy for non-cancer causes) 3. Have been without continuous Medical Services Plan (MSP = BC’s public insurance program) during the washout period and study period 4. Have had a cancer diagnosis or record of chemotherapy recorded in MSP fee-for-service claims, the hospital discharge abstract database, or the National Ambulatory Care Reporting System database during the study period or the preceding six months. Skin cancers (Basal Cell Carcinoma, Squamous Cell Carcinoma) were not excluded. Previous participant exclusion criteria as of 06/01/2021: Prescribers: 1. Currently residing outside of BC 2. Unavailable contact information (e.g., deceased, retired) 3. Not currently practicing (are retired), or who have not prescribed at least one opioid during the study period Patients: 1. Have been dispensed any opioids or opioid agonist therapies in the last six months (during the washout period) 2. On Plan B (long term care) or Plan P (palliative care) at any time during the washout period or study period (as a proxy for non-cancer causes) 3. Have been without continuous Medical Services Plan (public insurance program) during the washout period and study period 4. Have had a cancer diagnosis (not including skin cancers) or record of chemotherapy recorded in MSP fee-for-service claims, the hospital discharge abstract database, or the National Ambulatory Care Reporting System database during the study period or the preceding six months Previous participant exclusion criteria: 1. Currently residing outside of BC 2. Unavailable contact information (e.g., deceased, retired) 3. Not currently practicing (are retired), or who have not prescribed at least one opioid during the study period
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Current primary outcome measure as of 03/09/2021: The number of new opioid prescriptions initiated in opioid-naïve patients in the 6 months following the intervention, as recorded in the BC Ministry of Health administrative claims databases Previous primary outcome measure: The number of new opioid prescriptions to opioid-naïve patients in the last 12 months, calculated based on the administrative claims databases of the Ministry of Health in the last 6 months at the 6-month follow up. | — |
Secondary
| Measure | Time frame |
|---|---|
| Current secondary outcome measures as of 04/08/2023: Quantitative physician outcomes: 1. Estimated length of opioid use, measured in days from the first to the last prescription plus ‘days supply’ of the last dispensing at baseline and 6-month follow up 2. Median (and quartile ranges) for Morphine Equivalent Daily (MED) dosage, of all new opioid prescriptions initiated within the reporting period, prescribed by the provider _____ Previous secondary outcome measures as of 03/09/2021: Quantitative physician outcomes: 1. Estimated length of opioid use, measured in days from the first to the last prescription plus ‘days supply’ of the last dispensing at baseline and 6-month follow up 2. Median (and quartile ranges) for Morphine Equivalent Daily (MED) dosage, of all new opioid prescriptions initiated within the reporting period, prescribed by the provider Quantitative patient outcomes: 1. Number of hospitalizations and emergency department visits measured using data from the National Ambulatory Care Reporting System (NACRS) database, looking at the binary outcome ED visit (Yes/ No). This is a very limited measure that is applicable only to urban settings because small hospitals are not included in the database. _____ Previous secondary outcome measures: 1. Length of opioid prescriptions measured by counting the number of days of uninterrupted prescribing from initiation to cessation at baseline and 6-month follow-up 2. Average dose of opioid prescriptions measured by summing up the dose from all prescriptions and dividing the sum of all doses by the number of prescriptions at baseline and 6-month follow-up 3. Intervention experience measured using semi-structured focus groups among a purposive sample of end-users at 6-month follow-up | — |
Countries
Canada
Outcome results
None listed