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Completed

NCT Number: NCT03825549

A Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing

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.

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Key information

Conditions

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

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Sutter Heath

Walnut Creek, California, 94596, United States

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Clinicians
  • Practiced primarily at participating emergency department or urgent care center
  • Patients
  • Presented to a participating emergency department or urgent care center during the study period
  • Discharged to home from the visit

Exclusion criteria

  • Clinicians
  • Saw less than 100 patients in the prior year
  • Practiced primarily at another site that is not in the main trial
  • Did not practice at Sutter Health in the prior 90 days
  • Patients
  • Currently pregnant

Treatment and study plan

Individual audit feedback

Behavioral

Practice sites randomly assigned to have individual audit feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. The email will inform the clinician that the health system is doing monthly audits and provide them the number of patients in the last month for whom they prescribed 30 opioid pills per prescription or higher.

Peer comparison feedback

Behavioral

Practice sites randomly assigned to have peer comparison feedback will be sent information by email to each clinician at the site each month for the duration of the intervention period. Data on the mean number of opioid pills per prescription and the proportion of visits with an opioid prescription will be delivered using a 3-month rolling average as follows: a) If clinician is above median: informed how their data compares to the median; b) If clinician is below median but above 10th percentile: informed how their data compares to the 10th percentile; c) If clinician is 10th percentile or below: informed of their data and commended for being a "low prescriber."

Primary outcomes

  1. Change in the mean number of pills per opioid prescription

    Time frame: Six months

    The primary outcome is the change in the mean number of pills prescribed per opioid prescription from baseline to the intervention period.

Secondary outcomes

  1. Change in proportion of patient visits with an opioid prescription

    Time frame: Six months

    The secondary outcome is the change in proportion of patient visits in which an opioid is prescribed from baseline to the intervention period.

Other outcomes

  1. Change in morphine milligram equivalents per opioid prescription

    Time frame: Six months

    The change in morphine milligram equivalents per opioid prescription from baseline to the intervention period.

  2. Change in mean number of opioid pills per patient-visit

    Time frame: Six months

    The change in the mean number of opioid pills per patient-visit from baseline to the intervention period.

  3. Change in proportion of patient-visits with non-opioid pain prescription

    Time frame: Six months

    The change in proportion of patient-visits with non-opioid pain prescriptions (e.g., ibuprofen, acetaminophen, celecoxib, or muscle relaxants such as cyclobenzaprine, baclofen or tizanidine) from baseline to the intervention period.

Sponsors and collaborators

Lead sponsor

University of Pennsylvania

Other

Collaborators

  • Donaghue Medical Research Foundation
  • Sutter Health

Registry information

Acronym: REDUCE

Important dates

Study start
2019
Primary completion
2020
Study completion
2020
First posted
Jan 31, 2019
Registry last updated
Mar 6, 2020

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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