Harm Reduction, Medication Abuse
Conditions
Brief summary
The objective of this study is to evaluate the impact of clinical decision support (CDS) alert to notify providers when the opioid prescription being written will result in the patient transitioning into a new phase of opioid therapy. The 2022 CDC clinical practice guideline for prescribing opioids for pain recommends providers reassess patient pain as well as the risks and benefits of opioid therapy before patients transition from acute to subacute treatment (1 month of opioid analgesics) and when patients transition from subacute to chronic opioid treatment (3 months). This study will evaluate a clinical decision support tool identifying patients who will be transitioning between phases as a result of an opioid prescription and suggest a review of patient pain and goals. Primary care providers will be randomized at the clinic location to a control arm or intervention arm. The control arm will not be notified that the prescription transitions the patient to a new phase but will have access to the same patient pain scales and information. The intervention arm will receive a notification of the transition and suggest review of patient needs and encourage documentation. Opioid transition orders and outcomes of patients will be examined based on medical records data collected during routine care.
Interventions
OTHEROpioid Transitions Clinical Decision Support (CDS)
Clinical decision support in the form of an electronic health record (EHR) integrated, provider-facing alert suggesting (a) the patient is transitioning to a new phase of opioid therapy and (b) the provider should review patient pain data and pain management goals as suggested by 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
Any primary care encounter where an opioid is prescribed that transitions the patient to a different stage of opioid therapy (acute to subacute after 1 month of opioids; subacute to chronic after 3 months of an opioid)
Exclusion criteria
* Patients \<12 and \>89 * Patients with active cancer diagnosis in last 1 year * Patients with hospice care/palliative care order * Patients with sickle cell disease diagnosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of encounters with an opioid transitioning prescription | 18 months | The number of primary care encounters where an opioid prescription transitions a patient to a different phase of care (by phase) divided by the total number of opioid prescriptions |
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 documented a review of patient pain and goals |
| Subsequent opioid overdose/poisoning rates | Six months after an encounter where the opioid use disorder is identified | The number of patients who reached the threshold of chronic opioid use, had a diagnosis of opioid overdose/poisoning or a new diagnosis of opioid use disorder |
| Opioid prescription abandonment | 18 months | The proportion of opioid prescriptions initiated (triggering the CDS) and an opioid was not signed by the provider, indicating a change in clinical decision to prescribe an opioid |
| Number of patients with long term opioid use | Six months after an encounter where the opioid use disorder is identified | Count of patients receiving \>90 day supply of opioids |
Contacts
CONTACTHeather Tolle, PhD
PRINCIPAL_INVESTIGATORJason Hoppe, DO
University of Colorado, Denver
Outcome results
None listed