The Effect Of Clinician Feedback Interventions On Opioid Prescribing

Navathe, Amol S.; Liao, Joshua M.; Yan, Xiaowei; Delgado, M. Kit; Isenberg, William M; Landa, Howard M; Bond, Barbara L; Small, Dylan S.; Rareshide, Charles A. L.; Shen, Zijun; Pepe, Rebecca S.; Refai, Farah; Lei, Victor; Volpp, Kevin G.; Patel, Mitesh S.

doi:10.1377/hlthaff.2021.01407

Cited by 19 publications

(22 citation statements)

References 34 publications

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“…Despite the lower-than-anticipated rates of opioid prescribing and clinician exposure to multiple opioid prescribing interventions, we still observed statistically significant decreased odds of prescribing in the comparison groups, even before the initial comparison emails were sent. These results add to the growing literature that low-effect nudges can result in opioid prescribing changes and other health benefits, 24 , 25 , 30 , 31 , 32 , 33 even in the context of likely concurrent interventions.…”

Section: Discussionsupporting

confidence: 54%

“…Comparison can influence clinicians’ clinical practice. 21 , 22 , 23 , 24 , 25 Clinicians in the comparison group received the previously described EHR guideline as well as monthly feedback via email regarding initial opioid prescriptions for acute pain, adherence to safe opioid-prescribing guidelines, and the proportion of patients who received opioids for acute pain who transitioned to treatment with long-term opioid therapy (>3 months) (eFigure in Supplement 3 ) compared with other clinicians. As seen in the eFigure in Supplement 3 , the email text primarily described the meaning of the metrics in the figure, whereas the bar graphs depict the clinician’s performance, average of other clinicians’ performance, and performance of the lowest (best) 10% of clinicians.…”

Section: Methodsmentioning

confidence: 99%

“…Comparison can influence clinicians’ clinical practice . Clinicians in the comparison group received the previously described EHR guideline as well as monthly feedback via email regarding initial opioid prescriptions for acute pain, adherence to safe opioid-prescribing guidelines, and the proportion of patients who received opioids for acute pain who transitioned to treatment with long-term opioid therapy (>3 months) (eFigure in Supplement 3) compared with other clinicians.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2022

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Section: Discussionsupporting

confidence: 54%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2022

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“…Nudges, or interventions that seek to change behavior without directly limiting choices or changing incentives, provide one approach. 22,23 There are several examples of successful opioid prescribing nudges, including peer comparison feedback on pills per opioid prescription, 24 reduced default duration or quantity for new opioid prescriptions, [25][26][27][28] and letters to practitioners informing them that one of their patients overdosed. 29 Nudgelike interventions have also successfully reduced benzodiazepine prescribing.…”

Section: Introductionmentioning

confidence: 99%

Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers

et al. 2022

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ImportancePolicy makers have sought to discourage concurrent prescribing of opioids and benzodiazepines (coprescribing) because it is associated with overdose. Email alerts sent by pharmacists may reduce coprescribing, but this intervention lacks randomized evidence.ObjectiveTo investigate whether pharmacist emails to practitioners caring for patients who recently received opioids and benzodiazepines reduce coprescribing of these medications.Design, Setting, and ParticipantsRandomized clinical trial (intention to treat) conducted in 2019-2021 of patients and their practitioners (prescribers and primary care managers) in the National Capital Region of the Military Health System. Participants were 2237 patients who were recently coprescribed opioids and benzodiazepines. These patients had 789 practitioners eligible for emails.InterventionsPatients were randomized to email alerts to their practitioners or as-usual care. Clinical pharmacists sent the email alert. Messages were standardized and designed to facilitate coordination between practitioners, increase awareness of guidelines, and provide action steps and resources.Main Outcomes and MeasuresThe primary outcomes were patients’ days received of opioids, benzodiazepines, and concurrent opioids and benzodiazepines during the 90 days following enrollment evaluated using 1-sided hypothesis tests. Secondary outcomes included total prescribing of opioids and benzodiazepines by patients’ practitioners, including to patients outside the study, to test for broader outcomes on their prescribing.ResultsOf 2237 patients, 1187 were assigned to treatment and 1050 to control; 1275 (57%) were women. Patients received a mean (SD) of 31 (44) days of opioids and 33 (34) days of benzodiazepines in the 90 days before enrollment. There were no detected differences in the primary end points, including patients’ receipt of opioids (adjusted difference, 1.1 days; 95% CI, -∞ to 3.0; P = .81), benzodiazepines (adjusted difference, −0.6 days; 95% CI, -∞ to 1.4; P = .30), and opioids and benzodiazepines together (adjusted difference, −0.1 days; 95% CI, -∞ to 0.7; P = .41). Of 789 practitioners, 429 were considered the treatment group, 325 were considered controls, and 35 were excluded. There were no detected differences in practitioners’ total prescribing of opioids, benzodiazepines, or both drug classes together.Conclusions and RelevanceIn this randomized clinical trial of pharmacist emails to practitioners, email alerts failed to detectably reduce coprescribing, highlighting the value of alternative approaches. Combining randomization with quality improvement activities may help stakeholders seeking evidence-based interventions to encourage guideline-concordant care.Trial RegistrationClinicalTrials.gov Identifier: NCT03887247

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“…A separate study, undertaken in US emergency department settings in 2019-2020, compared peer comparison feedback alone or combined with individual audit and feedback with individual audit and feedback alone. 49 It showed that the peer comparison was effective, with a reduction of 0.8 pills per prescription rising to 1.2 pills per prescription when combined with audit and feedback, while individual audit and feedback alone was not effective. A UK study set in primary care during 2013 and 2017 provided comparative and practice-individualised reports, alongside persuasive messaging, recommended actions and action plans.…”

Section: Discussionmentioning

confidence: 99%

Reducing opioid use for chronic non-cancer pain in primary care using an evidence-based, theory-informed, multistrategic, multistakeholder approach: a single-arm time series with segmented regression

et al. 2023

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BackgroundMany countries have high opioid use among people with chronic non-cancer pain. Knowledge about effective interventions that could be implemented at scale is limited. We designed a national intervention that included audit and feedback, deprescribing guidance, information on catastrophising assessment, pain neuroscience education and a cognitive tool for use by patients with their healthcare providers.MethodWe used a single-arm time series with segmented regression to assess rates of people using opioids before (January 2015 to September 2017), at the time of (October 2017) and after the intervention (November 2017 to August 2019). We used a cohort with historical comparison group and log binomial regression to examine the rate of psychologist claims in opioid users not using psychologist services prior to the intervention.Results13 968 patients using opioids, 8568 general practitioners, 8370 pharmacies and accredited pharmacists and 689 psychologists were targeted. The estimated difference in opioid use was −0.51 persons per 1000 persons per month (95% CI −0.69, –0.34; p<0.001) as a result of the intervention, equating to 25 387 (95% CI 24 676, 26 131) patient-months of opioid use avoided during the 22-month follow-up. The targeted group had a significantly higher rate of incident patient psychologist claims compared with the historical comparison group (rate ratio: 1.37, 95% CI 1.16, 1.63; p<0.001), equating to an additional 690 (95% CI 289, 1167) patient-months of psychologist treatment during the 22-month follow-up.ConclusionsOur intervention addressed the cognitive, affective and sensory factors that contribute to pain and consequent opioid use, demonstrating it could be implemented at scale and was associated with a reduction in opioid use and increasing utilisation of psychologist services.

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The Effect Of Clinician Feedback Interventions On Opioid Prescribing

Cited by 19 publications

References 34 publications

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

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

Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers

Reducing opioid use for chronic non-cancer pain in primary care using an evidence-based, theory-informed, multistrategic, multistakeholder approach: a single-arm time series with segmented regression

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