Electronic Defaults to Reduce Opioid Prescribing in Emergency Department and Primary Care Settings

Study Overview
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Brief Summary
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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 primary care and emergency department 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 matched pairs of Montefiore Medical Center clinical sites, stratified by specialty and teaching status, 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
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A Cluster-randomized Trial of Modifying Electronic Health Record Defaults to Reduce the Prescribed Quantity of Opioid Analgesics in Primary Care and Emergency Department Settings

Conditions
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Acute Pain

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


Participation Criteria
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Eligibility Criteria
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Clinical Site Inclusion Criteria: Primary care clinic (internal medicine, family medicine, or urgent care) or emergency department within Montefiore Medical Center Patient Inclusion Criteria: Received a new opioid analgesic prescription, defined as no opioid analgesic prescription in the preceding 6 months Patient Exclusion Criteria: Cancer diagnosis code within the past 1 year

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<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> |
| 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?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Initial prescription <= 10 pills (y/n) | Extracted from the electronic medical record | Through study completion (18 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Initial prescription number of pills | Extracted from the electronic medical record | Through study completion (18 months) | 
| Initial prescription morphine milligram equivalents | Extracted from the electronic medical record | Through study completion (18 months) | 
| Opioid analgesic re-order (y/n) | Extracted from the electronic medical record | Within 30 days after the initial prescription | 
| Total opioid analgesic pills prescribed, including re-orders | Extracted from the electronic medical record | Within 30 days after the initial prescription | 
| Total morphine milligram equivalents prescribed, including re-orders | Extracted from the electronic medical record | Within 30 days after the initial prescription | 
| Outpatient visits | Extracted from the electronic medical record | Within 30 days after the initial prescription | 
| Emergency department visits | Extracted from the electronic medical record | Within 30 days after the initial prescription | 
| Hospitalizations | Extracted from the electronic medical record | Within 30 days after the initial prescription |