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OpenTrials
Completed

NCT Number: NCT05070338

Postoperative Nudges to Reduce Opioid Prescribing

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.

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Key information

Conditions

Opioid Prescribing Chemically-Induced Disorders Mental Disorders Narcotic-Related Disorders Opioid-Related Disorders Substance-Related Disorders

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Sutter Health

Sacramento, California, 95833, United States

Who can participate

Healthy volunteers accepted: No

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

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.

Treatment and study plan

Guideline-Based (Injunctive Norm) Nudges

Behavioral

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed.

Dear Dr. [Name],

In [month], at least XX of your patients were discharged with opioid prescriptions exceeding the amounts recommended by safety guidelines for these procedures.

For patient safety, Sutter Health recommends prescribing within the ranges below for these procedures. Doing so will also meet best-practice safety guidelines for post-operative opioid prescribing.

We will continue to send you opioid prescribing safety reports.

Sincerely, [Signature]

[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure]

Peer-Based (Social Norm) Nudges

Behavioral

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed.

Dear Dr. [Name],

In [month], at least XX of your patients were discharged with opioid prescriptions exceeding the amount prescribed by YY% of your peers for these procedures.

YY% of [specialty] surgeons at Sutter Health prescribe within the ranges below for these procedures.

We will continue to send you opioid prescribing safety reports.

Sincerely, [Signature]

[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure]

The ranges of 5mg oxycodone tablets displayed will be the same as the ranges stipulated by the prescribing guidelines, but this nudge will not mention guidelines.

Primary outcomes

  1. Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines

    Time frame: 12 months

    Prescriptions will be compared to prescribing guidelines via morphine milligram equivalents (MMEs) and coded as within or above guidelines. If no opioid is prescribed at discharge, this will be coded as within guidelines.

Secondary outcomes

  1. Morphine Milligram Equivalents (MMEs) Prescribed at Discharge

    Time frame: 12 months

    Continuous measure of the total morphine milligram equivalents prescribed at discharge

  2. Days' Supply of Opioids Prescribed at Discharge

    Time frame: 12 months

    Continuous variable indicating the number of days' supply of opioids prescribed at discharge

  3. Proportion of Discharges Where Any Opioid Was Prescribed

    Time frame: 12 months

    Derived from a binary variable indicating whether any opioid was prescribed at discharge

  4. Proportion of Patients on Opioids for Greater Than 3 Months Post-discharge

    Time frame: 3-6 months post-discharge

    Derived from a binary variable indicating whether the patient has any opioid prescriptions between 3 and 6 months after surgery

  5. Number of 30-day All-cause Emergency Department Visits

    Time frame: 0-30 days post-discharge

    Number of emergency department visits the post-operative patient has in the 30 days after the initial procedure

  6. Number of 30-day All-cause Hospitalizations

    Time frame: 0-30 days post-discharge

    Number of hospital admissions the post-operative patient has in the 30 days after the initial procedure

  7. Proportion of Discharge Opioid Prescriptions Above Prescribing Guidelines in the Year After the Intervention Ends

    Time frame: 12 months (months 13-24 of the study)

    Prescriptions will be compared to prescribing guidelines via morphine milligram equivalents (MMEs) and coded as within or above guidelines. If no opioid is prescribed at discharge, this will be coded as within guidelines.

Sponsors and collaborators

Lead sponsor

RAND

Other

Collaborators

  • Sutter Health
  • University of California, Los Angeles
  • University of Michigan
  • University of Southern California

Registry information

Official study title

Reducing Inappropriate Prescription Opioid Prescribing at Hospital Discharge

Acronym: POST-OP

Important dates

Study start
2021
Primary completion
2022
Study completion
2023
First posted
Oct 7, 2021
Registry last updated
Apr 8, 2025

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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