Effect of Different Interventions to Help Primary Care Clinicians Avoid Unsafe Opioid Prescribing in Opioid-Naive Patients With Acute Noncancer Pain

Abstract

This cluster randomized clinical trial compares clinician-facing interventions to prevent unsafe opioid prescribing in opioid-naive primary care patients with acute noncancer pain.

Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions

“…Prior efforts to change postoperative prescribing with behavioral interventions have used pretest-posttest designs and have shown reductions in the number of tablets prescribed. 15 , 35 , 36 , 37 , 38 , 39 The present work is consistent with trials testing clinician feedback interventions on opioid prescribing in emergency department, primary care, and urgent care sites, 14 , 17 , 40 , 41 , 42 , 43 although 2 other trials examining clinician feedback on concurrent prescribing of opioids and benzodiazepines did not show reductions 40 , 44 in concurrent prescribing. The finding that both the peer-based descriptive norm and guideline-based injunctive norm treatment conditions were equally effective contributes to an ongoing debate from the broader norms literature about which type of norm—descriptive or injunctive—is more likely to exert an effect in a fast-paced environment in which there is a great deal of cognitive depletion.…”

“…15,[35][36][37][38][39] The present work is consistent with trials testing clinician feedback interventions on opioid prescribing in emergency department, primary care, and urgent care sites,14,17,[40][41][42][43] although 2 other trials examining clinician feedback on concurrent prescribing of opioids and benzodiazepines did not show reductions40,44 in concurrent prescribing. The finding JAMA Health Forum | Original Investigation…”

Impact of Provider-Facing Interventions to Reduce Opioid Use on Pain Related Outcomes in Primary Care: A Cluster Randomized Trial

“…These findings add to the evidence supporting provider-facing interventions to reduce unsafe opioid prescribing and subsequent risk of misuse and chronic opioid therapy. 3 , 5 , 6 …”

“…Opioid analgesics can be prescribed to patients presenting with acute noncancer pain in primary care. 1 , 2 In a recent study, 3 we demonstrated that providers who received emails comparing their opioid prescribing patterns to other providers prescribed less opioids to patients presenting with acute noncancer pain at initial visits compared to providers following an electronic health record (EHR) guideline. In follow-up to this primary study, we examined patient reported pain, pain interference with function and activity, and treatment satisfaction across these different provider-facing interventions.…”