Electronic Defaults to Reduce Opioid Prescribing in Dentistry Practices

Study Overview
=================
Brief Summary
-----------------
The goal of this research is to investigate the impact of changing opioid analgesic prescribing defaults on the quantity of opioids prescribed for acute non-cancer pain in adult dentistry settings. We will change prescribing defaults for select short-acting opioid analgesics including immediate release oxycodone and hydrocodone as well as codeine and tramadol, including their co-formulations with acetaminophen. In a cluster-randomized trial of three Montefiore Medical Center dentistry sites, we will evaluate the impact of this intervention on patient-level outcomes using 18 months of data (6 months pre-intervention and 12 months post-intervention).

Official Title
-----------------
A Cluster-randomized Trial of Modifying Electronic Health Record Defaults to Reduce the Prescribed Quantity of Opioid Analgesics in Dentistry Practices

Conditions
-----------------
Acute Pain

Intervention / Treatment
-----------------
* Other: Change in electronic health record default for new opioid analgesic prescriptions


Participation Criteria
=================
Eligibility Criteria
-----------------
Clinical Site Inclusion Criteria: Dentistry clinic within Montefiore Medical Center Patient Inclusion Criteria: Received a new opioid analgesic prescription, defined as no opioid analgesic prescription in the preceding 6 months Exclusion Criteria: None

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 10-pill default<br>The intervention condition consists of a change to the electronic health record so that new opioid analgesic prescriptions automatically default to 10 pills (i.e., the quantity dispensed field is pre-populated). This value is modifiable by providers who can tailor the prescription based on clinical factors. | Other: Change in electronic health record default for new opioid analgesic prescriptions<br> <br> |
| Experimental: 5-pill default<br>New opioid analgesic prescriptions will automatically default to 5 pills. | Other: Change in electronic health record default for new opioid analgesic prescriptions<br> <br> |
| No Intervention: Standard of care<br>The control condition will be the usual electronic health record interface. The default number of pills varies by medication, most medications currently have either a blank default or a default of 30 pills. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Initial prescription number of pills to dispense | From the electronic health record | Through study completion (18 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Initial prescription morphine milligram equivalents to dispense | From the electronic health record | Through study completion (18 months) | 
| Opioid analgesic reorder (y/n) | From the electronic health record | Within 30 days after the initial prescription | 
| Total opioid analgesic pills to dispense, including re-orders | From the electronic health record | Within 30 days after the initial prescription | 
| Total morphine milligram equivalents to dispense, including re-orders | From the electronic health record | Within 30 days after the initial prescription | 
| Outpatient visits | From the electronic health record | Within 30 days after the index prescription | 
| Emergency department visits | From the electronic health record | Within 30 days after the initial prescription | 
| Hospitalizations | From the electronic health record | Within 30 days after the initial prescription |