Adverse Drug Effect of Benzodiazepines, Adverse Drug Effect of Opioids
Conditions
Keywords
Care coordination, Opioid, Benzodiazepine, Behavioral science, Behavioral economics, Nudge, Fragmentation of care, Concurrent prescribing
Brief summary
The purpose of this effort is to use informative e-mails to improve the process of prescribing of opioids and benzodiazepines within the National Capital Region/Military Health System (NCR/MHS), with the aim of decreasing concurrent opioid and benzodiazepine prescribing.
Detailed description
The purpose of this effort is to use low-cost informative e-mails to improve the process of prescribing of opioids and benzodiazepines within the National Capital Region/Military Health System (NCR/MHS), with the aim of decreasing concurrent opioid and benzodiazepine prescribing. Both the VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain (2017) and the CDC Guideline for Prescribing Opioids for Chronic Pain (2016) strongly recommend against the concurrent use of opioids and benzodiazepines. Taken together, these drugs could cause respiratory depression, enhanced sedation, and death. The intervention population will be prescribers and primary care managers associated with patients who have recently received concurrent prescriptions of opioids and benzodiazepines. Using a randomized approach, we will allocate the NCR/MHS providers associated with patients with concurrent prescriptions for opioids and benzodiazepines to one of two conditions: 1. E-mail alert - A messaging approach, in which we will send encrypted emails to the patient's opioid and benzodiazepine prescriber(s) and primary care manager that identify the concurrent prescriptions and detail the patient's prescription history, inform them of the VA/DoD guideline and risk to patient, and provide action steps and relevant resources. When multiple providers are involved, the email message will also encourage coordination across providers and provide relevant contact information 2. As-Usual - An as-usual approach, in which providers are not sent messages. These providers can access patient information through the MHS Opioid Registry as before.
Interventions
BEHAVIORALE-mail Alert
Encrypted email to the following providers: the patient's opioid prescriber(s), benzodiazepine prescriber(s), and/or primary care manager. If there is more than one provider, they are copied together on the same message. The email identifies the concurrent prescriptions, details the patient's prescription history, includes relevant VA/DoD guidelines, states the risk of concurrent prescribing to patient, and provides action steps and relevant resources. When multiple providers are involved, the message encourages the providers to coordinate with each other and provides provider contact information to facilitate this communication.
Sponsors
United States Department of Defense
General Services Administration (GSA)
Walter Reed National Military Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patient had an overlapping opioid-benzodiazepine prescription * At least one of the patient's providers (opioid prescribers, benzodiazepine prescribers, and/or PCM) is in the NCR
Exclusion criteria
* Patient has a cancer diagnosis * Patient is receiving palliative care * Patient is under 18 * Patient was previously allocated to a study condition
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overlapping Days | 90 days | Overlapping days of opioids and benzodiazepines, determined using the dates of service and days supply of the prescription drug fills |
| Opioid Days | 90 days | Days of opioids received |
| Benzodiazepine Days | 90 days | Days of benzodiazepines received |
Countries
United States
Outcome results
None listed