EHR-Based Medication Complete Communication Strategy to Promote Safe Opioid Use

Study Overview
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Brief Summary
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The purpose of this study is to test the effectiveness of an electronic health record based strategy in promoting safe use of opioid medications after an Emergency Department (ED) visit. The electronic health record (EHR)-based strategy was designed to enhance provider counseling about opioids and to standardize and simplify the information that patients receive.

Detailed Description
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Research has shown that patients frequently leave the emergency department without sufficient knowledge about how to safely use their newly prescribed opioid pain relievers. Additionally, educational interventions have the ability to increase patient knowledge about medications. In this study, education interventions will be implemented at the level of the EHR and prompt increased provider counseling with a goal of improving patient knowledge and safe use of opioids after ED discharge. The investigators will conduct a three-arm provider randomized controlled trial among English-speaking adults prescribed hydrocodone-acetaminophen to evaluate the effectiveness of the EMC2 strategy, with and without Short Message Service (SMS) text reminders, to improve patient understanding and safe use of their medication compared to usual care. This study will be conducted at an urban, academic emergency department (annual volume >85,000 patient visits) in Chicago, Illinois. English speaking patients will be recruited and assessed in person at baseline, and by phone at 2-4 days, 7-14 days, and 1 month after recruitment.

Official Title
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EHR-Based Medication Complete Communication Strategy to Promote Safe Opioid Use

Conditions
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Opioid Use, Unspecified

Intervention / Treatment
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* Behavioral: EMC2 Strategy
* Behavioral: SMS Text Reminders


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: To be eligible to enroll and remain in the study, patient subjects must meet all of the following criteria: Patient age 18 years and older English language speaking prescribed pill form of hydrocodone-acetaminophen opioid pain reliever own a cell phone with text messaging capabilities the patient is the person primarily responsible for administering medication Exclusion Criteria: Subjects will be excluded from the study if any of the following conditions are met: Aged <18 non-English speaking clinically unstable, psychologically impaired or intoxicated as judged by research staff member or emergency physician chronic opioid use, defined as daily or near daily use of opioid pain relievers for the past 90 days admitted to hospital unable to complete follow up phone interviews pregnant

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Employ the standard of care, no intervention | |
| Experimental: EMC2 strategy<br>Patients of providers randomized to EMC2 arm will received educational tool from the ED to support the understanding and safe use of opioids. A single-page medication information sheet with content from a patients perspective and following health literacy best practices. Prescribing instructions will be adapted to the Universal Medication Scheduled Take-Wait-Stop regimen for both the prescribing and dispensing of the medicine. This format uses simplified text and numeric characters to detail dose. Provider counseling prompts: The providers for patients in this arm will be prompted to encourage counseling both in the ED and at follow-up time points. These prompts include: 1) An automated prompt to the ED physician upon signing the order; 2) an automated message to the PCP (if an in-system PCP) notifying them of the ED visit, new prescription, and counseling request; and 3) a request for the pharmacist to counsel patient printed automatically on the prescription. | Behavioral: EMC2 Strategy<br>* Patients of providers randomized to the EMC2 arm will received study related educational tools at the time of their discharge including: (a) health-literacy appropriate MedSheet for hydrocodone-acetaminophen and (b) prescription written with Universal Medication Schedule Take-Wait-Stop language. Additionally, providers related to the patient will be prompted to counseling the patient including: (c) (c-1) ED providers prompted via EHR, (c-2) PCP prompted to counsel on follow-up visit via automated message and (c-3) pharmacists prompted to counsel via request printed on prescription.<br>|
| Experimental: EMC2 strategy + SMS Text Reminders<br>In addition to the EMC2 Strategy Arm, patients will received daily text message reminders about the safe use of opioids for 7 days. | Behavioral: EMC2 Strategy<br>* Patients of providers randomized to the EMC2 arm will received study related educational tools at the time of their discharge including: (a) health-literacy appropriate MedSheet for hydrocodone-acetaminophen and (b) prescription written with Universal Medication Schedule Take-Wait-Stop language. Additionally, providers related to the patient will be prompted to counseling the patient including: (c) (c-1) ED providers prompted via EHR, (c-2) PCP prompted to counsel on follow-up visit via automated message and (c-3) pharmacists prompted to counsel via request printed on prescription.<br>Behavioral: SMS Text Reminders<br>* In addition to the components of the EMC2 strategy arm, patients will received daily text message reminders about the safe use of opioids for 7 days.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safe Medication Dosing (Prescription Understanding) | Patient's ability to demonstrate correctly dosing their prescription opioid-acetaminophen pain reliever will be assessed through a series of questions. Correct dosing will be scored for each medication as yes/no reflecting having demonstrated all of the following: proper dose (# of pills), appropriate spacing (hours between doses), and total daily dose (not exceeding recommended daily dose). | 7-14 days after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medication Knowledge | The identification of the medications purpose, side effects, risks, warnings and benefits will be assessed through a structured questionnaire. Patients will be asked about each of the above via structured, open-ended items. Additionally, select questions from the validated Patient Opioid Education Measure and patient satisfaction questions will be included. The Patient Knowledge Score was developed from these questions, with a score range of 0 to 10. A higher score on the scale represents better patient knowledge. | 7-14 days after enrollment | 
| Proper Medication Use (Medication Diary) | Patients medication use will be assessed through a combination of a home medication diary (collected at 7-14 days post enrollment), pill count, and patient report of medication use. | 10 day medication diary | 
| Current Opioid Misuse Measure (COMM) | Select questions from the Current Opioid Misuse Measure (COMM) will be used to assess if patients are safely taking their prescription opioids. | 7-14 days after enrollment | 
| Pain Score | Pain scores through structured questions about use in the past 24 hours were collected from participants. Pain Score was assessed on a scale from 0 to 10, where higher numbers represent higher pain scores. | 7-14 days after enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Opioids