Harm Reduction, Medication Abuse, Opioid Overdose, Opioid Prescribing, Opioid Use Disorder, Prevention
Conditions
Brief summary
The 2022 Center for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends that when tapering a patient's opioid dose, doses should be decreased at a slow rate to reduce the risk of withdrawal symptoms, overdose, and to promote tolerance of the tapering. This project will evaluate a clinical decision support (CDS) tool in the form of a clinical care pathway that gives providers information, recommendations, and educational material on strategies for opioid tapering. Primary care providers will be randomized at the clinic location to a control arm or intervention arm. The control arm will have the clinical care pathway available, but will not be reminded of the pathway when tapering a patient. The intervention arm will receive a nudge when prescribing a tapering opioid strategy to a patient to use the clinical care pathway. The rate of opioid tapering in line with CDC guidelines will be examined as well as long-term patient outcomes of opioid overdose or poisoning using existing patient health records. The study period will be approximately 18 months.
Interventions
OTHEROpioid Tapering Pathway Clinical Decision Support (CDS)
Clinical decision support in the form of an electronic health record (EHR)-integrated, provider facing notification suggesting the provider utilize a clinical care pathway that provides resources and decision support in opioid tapering in line with CDC guidelines.
Sponsors
University of Colorado, Denver
National Institute on Drug Abuse (NIDA)
National Institutes of Health (NIH)
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 patients being tapered from an opioid. Tapering patients: * Have an active opioid prescription for more than 3 months and * Prescribed more than 90 morphine milligram equivalents (MME) per day or * Co-prescribed an opioid and benzodiazepine or * Received a reduction in opioid dosage by more than 5% MME per day
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 tapering within CDC guidelines | 18 months | The number of encounters where a provider's actions are in line with CDC tapering guidelines divided by the total number of opioid tapering 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 utilized the clinical care pathway |
| Subsequent opioid overdose/poisoning rates | 6 months after taper encounter | The number of patients who had a diagnosis of opioid overdose or poisoning in the six months following an opioid tapering prescription |
| Health care utilization | 6 months after taper encounter | The number of emergency department and clinic visits |
Contacts
CONTACTHeather Tolle, PhD
PRINCIPAL_INVESTIGATORJason Hoppe, DO
University of Colorado, Denver
Outcome results
None listed