Evaluation of Clinical Decision Support in Opioid Tapering

N/ANot Yet RecruitingNCT06527079

University of Colorado, Denver200,000 enrolled

Overview

The 2022 Center for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends that when tapering a patient's opioid dose, doses should be decreased at a slow rate to reduce the risk of withdrawal symptoms, overdose, and to promote tolerance of the tapering. This project will evaluate a clinical decision support (CDS) tool in the form of a clinical care pathway that gives providers information, recommendations, and educational material on strategies for opioid tapering. Primary care providers will be randomized at the clinic location to a control arm or intervention arm. The control arm will have the clinical care pathway available, but will not be reminded of the pathway when tapering a patient. The intervention arm will receive a nudge when prescribing a tapering opioid strategy to a patient to use the clinical care pathway. The rate of opioid tapering in line with CDC guidelines will be examined as well as long-term patient outcomes of opioid overdose or poisoning using existing patient health records. The study period will be approximately 18 months.

Study Type

OBSERVATIONAL

Enrollment

200,000

Conditions

Medication Abuse Harm Reduction Opioid Use Disorder Opioid Prescribing Opioid Overdose

Interventions

Opioid Tapering Pathway Clinical Decision Support (CDS)OTHER

Clinical decision support in the form of an electronic health record (EHR)-integrated, provider facing notification suggesting the provider utilize a clinical care pathway that provides resources and decision support in opioid tapering in line with CDC guidelines.

Eligibility

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

Medical Language ↔ Plain English

Inclusion Criteria: Primary care patients being tapered from an opioid. Tapering patients: * Have an active opioid prescription for more than 3 months and * Prescribed more than 90 morphine milligram equivalents (MME) per day or * Co-prescribed an opioid and benzodiazepine or * Received a reduction in opioid dosage by more than 5% MME per day Exclusion Criteria: * Patients \<12 and \>89 * Patients with active cancer diagnosis in last 1 year * Patients with hospice care/palliative care order * Patients with sickle cell disease diagnosis

Outcomes

Primary Outcomes

Percentage of encounters tapering within CDC guidelines

The number of encounters where a provider's actions are in line with CDC tapering guidelines divided by the total number of opioid tapering prescriptions

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

Time frame: 18 months

Subsequent opioid overdose/poisoning rates

The number of patients who had a diagnosis of opioid overdose or poisoning in the six months following an opioid tapering prescription

Time frame: 6 months after taper encounter

Health care utilization

The number of emergency department and clinic visits