provider-targeted behavioral interventions to prevent unsafe opioid prescribing for acute pain in primary care

Conditions: Acute Pain; Headache; Musculoskeletal Pain

Summary: the investigators will assess whether behavioral science-based interventions can "nudge" providers towards more evidence-based care for patients with acute non-cancer pain. aim 1) among opioid naïve primary care patients with acute non-cancer pain, compare the effect of the provider-targeted behavioral interventions (opioid justification and provider comparison), individually and in combination, on initial opioid prescription, initial use of non-opioid management, and patient-reported pain and function. aim 2) compare the effect of the 2 provider-targeted behavioral interventions, individually and in combination, on unsafe opioid prescribing and transition to chronic opioid therapy. aim 3) assess provider satisfaction and experience with the provider-targeted behavioral interventions. hypotheses: aim 1, h1a: compared with the guideline (usual care) alone, the addition of the opioid justification and provider comparison behavioral interventions will be associated with a decreased proportion of opioid prescription and increased proportion of non-opioid management at the initial outpatient visit for acute non-cancer pain. aim 1, h1b: compared with usual care (guideline) alone, the addition of the opioid justification and provider comparison behavioral interventions will be associated with no difference in patient-reported pain, function, and satisfaction at 1, 6, and 12 months. aim 2, h2: compared with the usual care (guideline), the addition of opioid justification and provider comparison behavioral interventions will be associated with a decreased proportion of patients receiving unsafe opioid therapy and a decreased proportion of patients transitioning to chronic opioid therapy. study design: pragmatic, cluster-randomized clinical trial in 48 primary care clinics. study population: the patient population will be 19,855 opioid naïve adults who present to clinic with acute uncomplicated musculoskeletal pain or headache. primary and secondary outcomes: the primary outcome measures will be receipt of an initial opioid prescription and unsafe opioid prescribing. secondary outcomes will be non-opioid pain management, and, in 514 patients, patient-reported pain and function. analytic plan: the investigators will test for differences in the primary and secondary outcomes among the 4 intervention groups. once completed, the project will provide evidence that health systems and other stakeholders need to implement interventions to prevent unsafe opioid prescribing.


Eligibility criteria:
1. patient participants inclusion criteria: * age 18 years or older; ii) index outpatient encounter with international classification of disease (icd)-10 code for acute neck, back, or other musculoskeletal and headache diagnosis ("acute" defined as no similar diagnosis in past 3 months). exclusion criteria: * cancer diagnosis (other than non-melanoma skin cancer) * receipt of opioid prescription within 12 months of index outpatient encounter 2. providers inclusion criteria: * primary care provider (md, doctor of osteopathy (do), physician assistant (pa), nurse practitioner (np)) at participating practice exclusion criteria: * none

Keywords: pragmatic clinical trial primary care provider-targeted behavioral intervention electronic health record