De-Implementing Opioids for Dental Extractions

Study Overview
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Brief Summary
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The overarching goal of this project is to de-implement the reliance on opioid analgesics and to implement reliance on non-opioid analgesics to manage postoperative pain following dental extractions. Using a prospective, provider-level, 3-arm cluster randomized trial design, the investigators will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients.

Detailed Description
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The primary objective of this project is to de-implement the use of opioid analgesics for the management of postoperative pain following dental extractions and to implement effective alternative pain management. The investigators propose a cluster-randomized trial design in which dental practitioners will be randomly assigned to 1 of 3 conditions involving different implementation strategies. The first condition, Standard Practice, will serve as a control condition. The second condition will implement a clinical decision support (CDS) tool that will extract patient history and interface with the state prescription drug monitoring program to provide personalized recommendations for analgesic prescribing and offer language for discussing optimal, evidence-based non-opioid pain management with dental extraction patients. The third condition will involve an enhanced version of the CDS (CDS-E) that will also include information regarding optimal, evidence-based, non-opioid pain management delivered directly to the patient both before and following the dental extraction visit. The investigators will examine opioid and non-opioid prescribing data from the electronic health record across study arms as well as other provider- and patient-focused outcomes using mixed methods.

Official Title
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De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions

Conditions
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Tooth Extraction

Intervention / Treatment
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* Other: Clinical Decision Support
* Other: Patient education


Participation Criteria
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Eligibility Criteria
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PATIENTS Inclusion Criteria: Have a dental extraction of a permanent teeth performed by an eligible HealthPartners provider during the intervention period Exclusion Criteria: Patients who have opted out of research at HealthPartners Meet above age criteria

Ages Eligible for Study
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Minimum Age: 16 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: Standard Practice<br>The patients in this arm were part of usual care with their dental provider. | |
| Experimental: Clinical Decision Support<br>A clinical decision support system designed to assist dentists in providing optimal pain management for patients without resorting to opioids when a non-opioid alternative would suffice. It provides pertinent clinical information to the dentist, including point-of-care access to the Prescription Drug Monitoring Program. | Other: Clinical Decision Support<br>* A clinical decision support system designed to assist dentists in providing optimal pain management for patients without resorting to opioids when a non-opioid alternative would suffice. It provides pertinent clinical information to the dentist, including point-of-care access to the Prescription Drug Monitoring Program.<br>|
| Experimental: Clinical Decision Support + Education<br>Patient education regarding pain management before and after dental extraction, including information about the risks and benefits of various strategies. | Other: Clinical Decision Support<br>* A clinical decision support system designed to assist dentists in providing optimal pain management for patients without resorting to opioids when a non-opioid alternative would suffice. It provides pertinent clinical information to the dentist, including point-of-care access to the Prescription Drug Monitoring Program.<br>Other: Patient education<br>* Patient education regarding pain management before and after dental extraction, including information about the risks and benefits of various strategies.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid Prescribing at the Extraction Encounter | Number of participants prescribed an opioid. | At the extraction encounter | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Exclusive Non-opioid Prescribing or Recommendations at the Extraction Encounter | Number of participants prescribed or recommended non-opioid analgesics (ibuprofen, naproxen, aspirin, or acetaminophen) and did not prescribe opioids (at the time of the extraction encounter). | At the extraction encounter | 
| Compare the Study Arm Differences in Shared Decision-making | The CollaboRATE scale measures shared decision making and consists of the mean of three items, each rated on a 0 (no effort was made) to 4 (every effort was made) scale. The possible range for the composite score is 0-4, with a higher score on the scale indicating that more shared decision-making occurred. | 3-6 days after the extraction encounter | 
| Compare the Study Arm Differences in Patient Experiences of Post-extraction Pain | Study arm comparison of the average patient-reported pain 3 days following the extraction encounter. (Numeric Rating Scale, 0 'no pain at all' - 10 'worst pain imaginable') | 3-6 days after the extraction encounter | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Decision Support Systems, Clinical, Pain Management, Analgesics