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.
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
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
Residents and visitors to the state of Colorado who seek healthcare within the University of Colorado Health (UCHealth) primary care system receiving long-term opioid treatment.
Cohort
Prospective
Opioid Tapering Pathway Clinical Decision Support (CDS)
Other interventionClinical 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.
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
Clinical decision support (CDS) acceptance rate
The number of times providers accepted the clinical decision support (CDS) tool and utilized the clinical care pathway
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
Health care utilization
The number of emergency department and clinic visits
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University of Colorado, Denver
Lead sponsor
National Institute on Drug Abuse (NIDA)
Collaborator
National Institutes of Health (NIH)
Collaborator
This trial is not recruiting at the moment. You can still explore other options:
