Clinical trial NCT03825549: A Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing
Official title: A Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Acute Pain
Keywords: Opioids
Nudges
Emergency Medicine
Urgent Care
Feedback
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
Collaborators: name: Donaghue Medical Research Foundation
name: Sutter Health
First posted: 2019-01-31
Enrollment: 452
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: In this study, the investigators will evaluate the effect of a health system initiative aiming to change clinician opioid prescribing behaviors using two behavioral economic interventions - individual audit feedback and peer comparison feedback of clinicians.

Detailed description: Opioid-related abuse and overdose represent a growing national epidemic in the United States. Clinician practice patterns play an important role: opioid prescriptions impact the likelihood that patients will misuse or become dependent on these medications, with longer prescriptions leading to greater sustained use. In this study, we will evaluate a Sutter Health System quality improvement initiative using monthly individual audit feedback and/or monthly peer comparison feedback to clinicians to change opioid prescribing patterns. In partnership with Sutter Health System, this will be conducted using randomization to evaluate its effect. We will also conduct a process evaluation to understand factors associated with better or worse performance at the clinician level.

Eligibility criteria: Inclusion Criteria:

* Clinicians

  1. Practiced primarily at participating emergency department or urgent care center
* Patients

  1. Presented to a participating emergency department or urgent care center during the study period
  2. Discharged to home from the visit

Exclusion Criteria:

* Clinicians

  1. Saw less than 100 patients in the prior year
  2. Practiced primarily at another site that is not in the main trial
  3. Did not practice at Sutter Health in the prior 90 days
* Patients

  1. Currently pregnant

Primary outcomes:
measure: Change in the mean number of pills per opioid prescription
timeFrame: Six months
Secondary outcomes:
measure: Change in proportion of patient visits with an opioid prescription
timeFrame: Six months
Other outcomes:
measure: Change in morphine milligram equivalents per opioid prescription
timeFrame: Six months
measure: Change in mean number of opioid pills per patient-visit
timeFrame: Six months
measure: Change in proportion of patient-visits with non-opioid pain prescription
timeFrame: Six months
Locations:
city: Walnut Creek
country: United States
facility: Sutter Heath
state: California
Study officials:
affiliation: University of Pennsylvania
name: Mitesh Patel, MD, MBA, MS
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Pennsylvania
name: Amol Navathe, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: