Default Dosing Settings for Opioid Prescriptions to Adolescents and Young Adults After Tonsillectomy

University of Michigan198 enrolled

Overview

This study will evaluate whether lowering the default number of doses for opioid prescriptions written in an electronic health record system can decrease opioid prescribing without causing unintended consequences such as worsened pain control.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

198

Conditions

Tonsillectomy

Interventions

Default setting interventionBEHAVIORAL

The new default settings will be implemented only for patients in the experimental arm.

Eligibility

Sex: ALLMin age: 12 YearsMax age: 25 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adolescents and young adults aged 12-25 years undergoing tonsillectomy at C.S. Mott Hospital, University Hospital, Brighton Center for Specialty Care, or Livonia Center for Specialty Care from October 2019-July 2021, excluding April-May 2020 (owing to suspension of elective procedures due to COVID-19). * Surgeon belongs to the Department of Otolaryngology at the University of Michigan Medical School * Patients are not any of the following: patients living in foster care or with a legal guardian, patients with medical complexity or developmental delays, non-English speaking patients, patients with recent suicidal ideation documented in their chart, or patients undergoing emergent tonsillectomy. Exclusion Criteria: * Patients with prescription opioid use prior to surgery * Patients undergoing additional procedures at the same time as tonsillectomy (other than minor procedures such as tympanostomy tube placement) * Patients enrolled in another study * Patients who are not prescribed opioids post-operatively at discharge * Patients who are enrolled in the Michigan Pain-control Optimization Pathway (M-POP), which includes education about pain management and a small initial opioid prescription * Patients with hospitalization with length of stay \> 1 day after surgery * Patients who decline to enroll * Additional exclusion criteria for secondary analysis: Patients who do not complete the baseline and post-operative day 14 surveys

Locations (1)

The University of Michigan

Ann Arbor, Michigan, United States

Outcomes

Primary Outcomes

Number of Doses in the Initial Discharge Opioid Prescription

Doses are defined as the maximum number of instances a patient could take opioids if they took them as prescribed. Number of doses are calculated from the electronic health record.

Time frame: Day of discharge, approximately 1 day

Proportion of Patients for Whom the Number of Doses in the Discharge Opioid Prescription Equals the Number of Doses in the New Default Settings

The new default settings called for 12 doses in the discharge prescription. This measure assesses the proportion of participants with 12 doses in the discharge prescription, regardless of which arm they were in. Doses are defined as the maximum number of instances a patient could take opioids if they took them as prescribed. Number of doses are calculated from the electronic health record.

Time frame: Day of discharge, approximately 1 day

Proportion of Participants Who Had at Least One Opioid Prescription Refill From University of Michigan During the Two Weeks After Surgery

Doses are defined as the maximum number of instances a patient could take opioids if they took them as prescribed. Number of doses are calculated from the electronic health record.

Time frame: Day 14

Proportion of Patients Who Visited or Saw a University of Michigan Provider Due to Pain During the Two Weeks After Surgery

Detailed in electronic health record. Excludes emergency department visits and hospitalizations for pain.

Time frame: Day 14

Proportion of Patients With at Least One Emergency Department and/or Hospitalization at University of Michigan for Pain During the Two Weeks After Surgery

Detailed in electronic health record

Time frame: Day 14

Secondary Outcomes

Data from ClinicalTrials.gov

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Overall Satisfaction Score on Pain Control During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Participants were surveyed on Day 14 and asked to report level of satisfaction with pain control since their surgery. Pain control satisfaction is on a scale of 1-10 with higher scores indicating higher satisfaction

Time frame: Day 14

Proportion of Patients Who Reported That Their Pain Was Well-controlled as Measured by the Post-operative Survey.

Time frame: Day 14

Proportion of Patients Whose Overall Pain Control Was Rated as Much Worse or Worse Than Expected as Measured by the Post-operative Survey.

Survey was comprised of 5 options: * Much worse than you expected * Worse than you expected * About what you expected * Better than you expected * Much better than you expected

Time frame: Day 14

Proportion of Patients Whose Pain Has Resolved by Day 14 After Surgery as Measured by the Post-operative Survey.

Survey asked participant on what day pain had resolved. If participants indicated pain had resolved by Day 14, then they were coded as 1, and 0 otherwise.

Time frame: Day 14

Pain in the Throat and/or Mouth Over the Past 7 Days at Its Worst as Measured by the Post-operative Survey.

Pain control is on a scale of 0-10 with higher scores indicating more pain.

Time frame: Day 14

Pain in the Throat and/or Mouth Over the Past 7 Days on Average as Measured by the Post-operative Survey.

Pain control is on a scale of 0-10 with higher scores indicating worse pain.

Time frame: Day 14

Proportion of Patients With Leftover Doses of Opioids as Measured by the Post-operative Survey.

Participants who answered 'No' to the following question: Did you take all of the opioid pain medications that were prescribed to you during the two weeks after surgery?

Time frame: Day 14

Number of Opioid Doses Taken During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Patients were asked to report the number of instances in which they used opioids prescribed to them.

Time frame: Day 14

Proportion of Patients Who Misused Opioids Prescribed to Others at Least Once During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Includes any use of opioids prescribed to others

Time frame: Day 14

Proportion of Patients Who Misused Opioids Prescribed to Them at Least Once During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Includes taking one's own opioids in greater amounts, more often, or longer than directed by a doctor.

Time frame: Day 14

Patient Health Questionnaire 8-item (PHQ-8) Score (Depression) as Measured by the Post-operative Survey.

This is an 8-item self-report scale, all items are rated on a score of 0-3, for a total range of 0-24. Higher scores indicate more depressive symptoms

Time frame: Day 14

Patient-Reported Outcomes Measurement Information System (PROMIS)- Pediatric Anxiety - Short Form 8a Score as Measured by the Post-operative Survey.

This measure is 8 items each scored from 1 to 5 points, with the lowest possible raw score being 8 and the highest possible raw score being 40. Higher scores indicate greater anxiety,

Time frame: Day 14

Patient-Reported Outcomes Measurement Information System (PROMIS)- Sleep Disturbance - Short Form 4a Score as Measured by the Post-operative Survey.

This measure is 4 items each scored from 1 to 5 points, with the lowest possible raw score being 8 and the highest possible raw score being 40. Higher scores indicate greater sleep disturbance, i.e. worse sleep.

Time frame: Day 14

Proportion of Patients Who Saw Their Primary Care Doctor (or a Colleague) in the Office Due to Pain at Least Once During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Time frame: Day 14

Proportion of Patients Who Visited a Retail Clinic Due to Pain at Least Once During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Time frame: Day 14

Proportion of Patients Who Visited an Urgent Care Center Due to Pain at Least Once During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Time frame: Day 14

Proportion of Patients Who Visited an Emergency Department and/or Were Hospitalized Due to Poorly Controlled Pain at Least Once During the Two Weeks After Surgery as Measured by the Post-operative Survey.

Time frame: Day 14

Proportion of Patients With Leftover Doses Who Disposed of Them

Proportion of patients with leftover doses who disposed of them

Time frame: 14 Days