Clinical trial NCT05070338: Postoperative Nudges to Reduce Opioid Prescribing
Official title: Reducing Inappropriate Prescription Opioid Prescribing at Hospital Discharge
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Opioid Prescribing
Keywords: Opioid Epidemic
Inappropriate Prescribing
Opioid-Related Disorders
Practice Guideline
Peer Influence
Nudges
Lead sponsor: RAND
Sponsor class: OTHER
Collaborators: name: Sutter Health
name: University of California, Los Angeles
name: University of Southern California
name: University of Michigan
First posted: 2021-10-07
Enrollment: 640
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study tests the effectiveness of two email-based behavioral nudges, one based on peer behavior and one based on best practice guidelines, in reducing excessive opioid prescriptions after surgery. It will be conducted in three surgical specialties (general surgery, orthopedic surgery, and obstetric/gynecological surgery) at 19 hospitals within one healthcare system. These specialties will each be randomized to a control group or one of two nudge groups. Each month for one year, surgeons in the nudge groups will receive emails comparing their opioid prescribing either to their peers' prescribing or to prescribing guidelines. Both types of email-based nudges are expected to reduce opioid prescribing after surgery.


Eligibility criteria: The nudges that a surgeon in either intervention arm will receive are based on that surgeon's eligible discharge opioid prescriptions in the previous month. Eligible prescriptions meet all of the following criteria:

* the patient is at least 18 years old at the date of surgery
* the patient is discharged to their home
* the surgical procedure has an applicable post-operative opioid prescribing guideline
* the surgical procedure is the only surgical procedure performed during the patient's hospital stay
* the prescription is for an opioid taken orally (tablets, capsules, or liquid solution)

To avoid contamination between the intervention arms, surgeons who operate across multiple surgical specialties (defined as surgeons who performed less than 90% of their total procedures in one specialty between June 2020 and May 2021) will not be eligible.

Primary outcomes:
measure: Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines
timeFrame: 12 months
Secondary outcomes:
measure: Morphine Milligram Equivalents (MMEs) Prescribed at Discharge
timeFrame: 12 months
measure: Days' Supply of Opioids Prescribed at Discharge
timeFrame: 12 months
measure: Proportion of Discharges Where Any Opioid Was Prescribed
timeFrame: 12 months
measure: Proportion of Patients on Opioids for Greater Than 3 Months Post-discharge
timeFrame: 3-6 months post-discharge
measure: Number of 30-day All-cause Emergency Department Visits
timeFrame: 0-30 days post-discharge
measure: Number of 30-day All-cause Hospitalizations
timeFrame: 0-30 days post-discharge
measure: Proportion of Discharge Opioid Prescriptions Above Prescribing Guidelines in the Year After the Intervention Ends
timeFrame: 12 months (months 13-24 of the study)
Other outcomes:
Locations:
city: Sacramento
country: United States
facility: Sutter Health
state: California
Study officials:
affiliation: RAND
name: Katherine E Watkins, MD, MSHS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Kirkegaard A, Wagner Z, Mariano LT, Martinez MC, Yan XS, Romanelli RJ, Watkins KE. Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial. BMJ Open. 2022 Sep 19;12(9):e061980. doi: 10.1136/bmjopen-2022-061980.