Electronic Defaults to Reduce Opioid Prescribing in Dentistry Practices

NCT03030469 | Completed

• 1 other identifier: 2016-7373
• Study Type: interventional
• Target: 10,000
• Locations: 0 countries
• Sites: N/A

Brief Summary

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 dentistry 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 three Montefiore Medical Center dentistry sites, 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).

Conditions

Acute Pain

Outcome Measures

Primary Outcomes (1)

• Initial prescription number of pills to dispense

  From the electronic health record

  Through study completion (18 months)

Secondary Outcomes (7)

• Initial prescription morphine milligram equivalents to dispense

  Through study completion (18 months)

• Opioid analgesic reorder (y/n)

  Within 30 days after the initial prescription

• Total opioid analgesic pills to dispense, including re-orders

  Within 30 days after the initial prescription

• Total morphine milligram equivalents to dispense, including re-orders

  Within 30 days after the initial prescription

• Outpatient visits

  Within 30 days after the index prescription

Study Arms (3)

10-pill default

EXPERIMENTAL

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

5-pill default

EXPERIMENTAL

New opioid analgesic prescriptions will automatically default to 5 pills.

Other: Change in electronic health record default for new opioid analgesic prescriptions

Standard of care

NO INTERVENTION

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.

Interventions

Change in electronic health record default for new opioid analgesic prescriptions OTHER

10-pill default; 5-pill default

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Dentistry clinic within Montefiore Medical Center
• Received a new opioid analgesic prescription, defined as no opioid analgesic prescription in the preceding 6 months

You may not qualify if:

• None

Sponsors & Collaborators

• Montefiore Medical Center: lead
• Albert Einstein College of Medicine: collaborator

Related Publications (1)

• Bachhuber MA, Nash D, Southern WN, Heo M, Berger M, Schepis M, Sugarman OK, Cunningham CO. Reducing Opioid Analgesic Prescribing in Dentistry Through Prescribing Defaults: A Cluster-Randomized Controlled Trial. Pain Med. 2023 Jan 4;24(1):1-10. doi: 10.1093/pm/pnac106.

  PMID: 35792881 DERIVED

MeSH Terms

Conditions

Acute Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Marcus Bachhuber, MD

  Montefiore Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: December 19, 2016
• First Posted: January 25, 2017
• Study Start: December 1, 2016
• Primary Completion: July 13, 2018
• Study Completion: July 13, 2018
• Last Updated: August 14, 2018

Record last verified: 2018-08