Harm Reduction, Medication Abuse, Opioid Use Disorder, Supportive Care
Conditions
Brief summary
The objective of this study is to evaluate the impact of clinical decision support (CDS) in the form of an alert to identify patients who may be at risk of opioid use disorder (OUD) and a clinical care pathway helping providers treating patients with opioid use disorder. The pathway provides health care providers with information and suggestions for screening and treatment of opioid use disorder, including treatment with medications. The 2022 Centers for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends providers asses for and treat opioid use disorder using approved medications for opioid use disorder (MOUD). This project will randomize primary care providers at the clinic level to a control arm or intervention arm. The control arm will have access to the clinical care pathway, but will not be reminded to utilize the pathway when treating a patient with opioid use disorder. The intervention arm will receive a reminder nudge about the pathway. Buprenorphine (a medication used to treat opioid use disorder) prescribing behavior of providers and outcomes of patients will be examined based on medical records data collected during routine care. The study period will be approximately 18 months.
Interventions
OTHERMedications for Opioid Use Disorder Pathway Clinical Decision Support (CDS)
Clinical decision support (CDS) in the form of an electronic health record (EHR)-integrated, provider-facing notification suggesting (a) the patient may be at risk for opioid use disorder and could benefit from screening, (b) patients with opioid use disorder would benefit from treatment with buprenorphine and (c) utilization of a clinical care pathway to help treat patients with opioid use disorder with buprenorphine as suggested by the Center for Disease Control and Prevention (CDC) guidelines.
Sponsors
University of Colorado, Denver
National Institutes of Health (NIH)
National Institute on Drug Abuse (NIDA)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
12 Years to 89 Years
Healthy volunteers
Yes
Inclusion criteria
* Primary care encounter AND * Current opioid prescription (not buprenorphine) and Active opioid medications over the last 90 days OR * Documented as on local Pain Registry "Does the patient fit the criteria to be included on the Pain Registry?" OR * Has active problem list diagnosis of long-term (current) use of opiate analgesic OR * Is taking \>=90 morphine milligram equivalents (MME) per day OR * Prior positive toxicology screen for illicit drugs OR * Diagnosis of opioid use disorder
Exclusion criteria
* Active cancer diagnosis in the last 1 year * Hospice care/palliative care order * Sickle cell disease diagnosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of patients at risk for opioid use disorder receiving medications for opioid use disorder | 18 months | The number of primary care patients identified to be at risk for opioid use disorder treatment with buprenorphine for treatment divided by the total number of patients meeting opioid use disorder criteria |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical decision support (CDS) acceptance rate | 18 months | The number of times providers accepted the clinical decision support (CDS) tool and utilized the clinical care pathway in treating opioid use disorder. |
| Subsequent opioid overdose/poisoning rates | Six months after an encounter where the opioid use disorder is identified | The number of patients who had a diagnosis of opioid overdose or poisoning |
| Buprenorphine initiation | Six months after an encounter where the opioid use disorder is identified | Number of patients who filled a buprenorphine prescription after being identified at risk. |
Contacts
CONTACTHeather Tolle, PhD
PRINCIPAL_INVESTIGATORJason Hoppe, DO
University of Colorado, Denver
Outcome results
None listed