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BMJ Open. 2018 Apr 20;8(4):e019559. doi: 10.1136/bmjopen-2017-019559.

Reducing the default dispense quantity for new opioid analgesic prescriptions: study protocol for a cluster randomised controlled trial.

Author information

1
Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, New York, USA.
2
Institute for Implementation Science in Population Health, City University of New York (CUNY), New York City, New York, USA.
3
Department of Epidemiology and Biostatistics, School of Public Health, City University of New York (CUNY), New York City, New York, USA.
4
Division of Hospital Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, New York, USA.
5
Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, New York, USA.
6
Montefiore Information Technology, Montefiore Medical Center, New York City, New York, USA.

Abstract

INTRODUCTION:

As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing.

METHODS AND ANALYSIS:

This study is a prospective cluster randomised controlled trial with two parallel arms. Primary care sites (n=32) and emergency departments (n=4) will be randomised in matched pairs to either a modification of the EHR so that new opioid analgesic prescriptions default to a dispense quantity of 10 tablets (intervention) or to no EHR change (control). The dispense quantity will remain fully modifiable by providers in both arms. From 6 months preintervention to 18 months postintervention, patient-level data will be analysed (ie, the patient is the unit of inference). Patient eligibility criteria are: (A) received a new opioid analgesic prescription, defined as no other opioid analgesic prescription in the prior 6 months; (B) age ≥18 years; and (C) no cancer diagnosis within 1 year prior to the new opioid analgesic prescription. The primary outcome will be the quantity of opioid analgesics prescribed in the initial prescription. Secondary outcomes will include opioid analgesic reorders and health service utilisation within 30 days after the initial prescription. Outcomes will be compared between study arms using a difference-in-differences analysis.

ETHICS AND DISSEMINATION:

This study has been approved by the Montefiore Medical Center/Albert Einstein College of Medicine Institutional Review Board with a waiver of informed consent (2016-6036) and is registered on ClinicalTrials.gov (NCT03003832, 6 December 2016). Findings will be disseminated through publication, conferences and meetings with health system leaders.

TRIAL REGISTRATION NUMBER:

NCT03003832; Pre-results.

KEYWORDS:

acute pain; default; electronic health record; opioid analgesics; pain management

PMID:
29678969
PMCID:
PMC5914704
DOI:
10.1136/bmjopen-2017-019559
[Indexed for MEDLINE]
Free PMC Article

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