Clinical Decision Support to Increase Use of Medications for Opioid Use Disorder

University of Colorado, Denver200,000 enrolled

Overview

The objective of this study is to evaluate the impact of clinical decision support (CDS) in the form of an alert to identify patients who may be at risk of opioid use disorder (OUD) and a clinical care pathway helping providers treating patients with opioid use disorder. The pathway provides health care providers with information and suggestions for screening and treatment of opioid use disorder, including treatment with medications. The 2022 Centers for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends providers asses for and treat opioid use disorder using approved medications for opioid use disorder (MOUD). This project will implement a passive CDS alert when a provider prescribes an opioid to a patient who may be at risk of opioid use disorder. Providers will also have link access to a clinical care pathway providing support for OUD screening and treatment. Before and after comparisons of buprenorphine (a medication used to treat opioid use disorder) prescribing by providers and outcomes of patients will be examined based on medical records data collected during routine care. The study period will be approximately 18 months.

Study Type

OBSERVATIONAL

Enrollment

200,000

Conditions

Medication Abuse Harm Reduction Opioid Use Disorder Supportive Care

Medications for Opioid Use Disorder Pathway Clinical Decision Support (CDS)OTHER

Clinical decision support (CDS) in the form of an electronic health record (EHR)-integrated, provider-facing notification suggesting (a) the patient may be at risk for opioid use disorder and could benefit from screening, (b) patients with opioid use disorder would benefit from treatment with buprenorphine and (c) utilization of a clinical care pathway to help treat patients with opioid use disorder with buprenorphine as suggested by the Center for Disease Control and Prevention (CDC) guidelines.

Eligibility

Sex: ALLMin age: 12 YearsMax age: 89 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Primary care encounter AND * Current opioid prescription (not buprenorphine) and Active opioid medications over the last 90 days OR * Documented as on local Pain Registry "Does the patient fit the criteria to be included on the Pain Registry?" OR * Has active problem list diagnosis of long-term (current) use of opiate analgesic OR * Is taking \>=90 morphine milligram equivalents (MME) per day OR * Prior positive toxicology screen for illicit drugs OR * Diagnosis of opioid use disorder Exclusion Criteria: * Active cancer diagnosis in the last 1 year * Hospice care/palliative care order * Sickle cell disease diagnosis

Outcomes

Primary Outcomes

Percentage of patients at risk for opioid use disorder receiving medications for opioid use disorder

The number of primary care patients identified to be at risk for opioid use disorder treatment with buprenorphine for treatment divided by the total number of patients meeting opioid use disorder criteria

Time frame: 18 months

Secondary Outcomes

Clinical decision support (CDS) acceptance rate

The number of times providers accepted the clinical decision support (CDS) tool and utilized the clinical care pathway in treating opioid use disorder.

Time frame: 18 months

Subsequent opioid overdose/poisoning rates

The number of patients who had a diagnosis of opioid overdose or poisoning

Time frame: Six months after an encounter where the opioid use disorder is identified

Buprenorphine initiation

Number of patients who filled a buprenorphine prescription after being identified at risk.