Opioid UseNCT04043143
24-hour Oral Morphine Equivalent Based Opioid Prescribing After Surgery
A study testing Arm 1 Prescription As Usual and Arm 2 Prescription Tool Intervention in people with Opioid Use, run by University of Colorado, Denver at 1 site in United States.
Trial summary
The investigators will utilize the electronic health record to individualize pain therapy in surgical patients after hospital discharge using last 24-hour opioid intake as the decision variable for the amount of opioid pain pills prescribed. Read more about this study
- Who is it for?
- Ages 18 to 60 years, women only
- Conditions the study is for
- Opioid Use
- What is being tested?
- Arm 1 Prescription As Usual and Arm 2 Prescription Tool Intervention
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 57 participants
- Where
- 1 siteUnited States
- Study dates
- 24 Oct 2019to 13 Jan 2021
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 60 years
- Women only
- No healthy volunteers
- Adult
Who may be able to join
- Women ages at least 18 years of age having undergone Cesarean section surgery at the University of Colorado Hospital are eligible.
- Willingness to complete weekly surveys for 4 weeks after discharge.
- Anticipated to need half or less of the usually prescribed amount of opioids based on the amount of opioids taken in the last 24 hours prior to the opioid medication being written for discharge (only patients who took 22.5 MME or less opioids in the last 24 hours prior to the day of discharge will be eligible for this study).
Who cannot join
- Patients under the age of 18 years.
- Patients returning to institutional settings (e.g. prison, jail, mental health facility).
- Pregnant women (patients will be approached after their C-section).
- Decisionally challenged patients.
- Blind or illiterate patients.
- Based on prior research factors such as emergency status, prior opioid use, repeat vs primary C-section, and associated procedures were not associated with post-discharge opioid use once the investigators adjusted for last-24 hour inpatient opioid use. Hence, these patients will not be excluded.
- Inclusion and exclusion criteria (including the amount of opioids taken in the last 24 hours prior to discharge) will be evaluated in the morning in patients scheduled to be discharged later that day.
Trial locations and contacts
1 site in 1 country.
About this study
The investigators will utilize the electronic health record to individualize pain therapy in surgical patients after hospital discharge using last 24-hour opioid intake as the decision variable for the amount of opioid pain pills prescribed. The preliminary data indicate that current opioid prescription practice after surgery follows a "one size fits all" pattern. In-hospital opioid use 24 hours prior to discharge serves as a strong indicator to correctly estimate needs for analgesic medications at home. The investigators will test the hypothesis that this prescription estimation tool will enable providers to write need-based prescriptions based on each patient's' 24-hour prior-to-discharge opioid use. The investigators will test this tool prospectively for patients after Cesarean section who are anticipated to use about half or less of the usually prescribed amount of opioid pain pills after discharge randomized equally to prescription tool intervention or no intervention (prescription as usual).
Read the detailed description
Prescription opioid overdose has emerged as a leading cause of death in the general population. Opioid-based therapy represents a corner-stone of post-operative pain management. With increasing emphasis on robust pain therapy, sales of opioid medications have increased four-fold in the last decade. Parallel to this rise, opioid-associated deaths have also quadrupled. The investigators have shown that long-term opioid use occurs in up to 22% of patients following surgery. Over-prescribed opioids after surgery can create a reservoir of opioids that become available for non-medical use. Effective strategies to maximize non-opioid pain therapy and to limit such a reservoir are lacking. Thus, there is an urgent need to individualize post-operative pain therapy and reduce reliance on opioids.
Converting knowledge on actual need for opioid pain medications after surgery into tangible benefits can prevent over-prescription of opioids that become available for non-medical use. The objective of this study is to prescribe pain medications after surgery in a patient-centered fashion. The investigators will use the average amount of opioid medications (in oral morphine equivalents - OME) taken in the last 24 hours prior to discharge to inform and design a clinical decision support tool. This tool will reduce the amount of opioid medications prescribed while maintaining patient post-operative pain control. The calculated "last 24 hour OME dose" will be applied to generate a recommendation for the prescription of a cumulative opioid dose that will be shared with the provider when the post-discharge pain medication is made, e.g. via displaying the last 24-hour opioid use in the electronic health record (EHR). The rationale is that testing of such a decision-making tool will lay the groundwork to translate the findings of this project into more secure and efficient opioid prescribing practices to a system-wide level. Upon completion, the investigators expect to have developed an effective decision-making tool to help providers estimate required pain medication following patient discharge.
The investigators will perform a randomized clinical trial (RCT) of an Electronic Health Record (EHR)-based recommendation to prescribe opioids at discharge according to the recorded last 24-hour inpatient use according to current recommendations and evaluate its effect on the amount of opioids prescribed as well as pain control after discharge.
Using the University of Colorado Hospital Epic/Clarity database, the investigators will continuously identify all patients who underwent Cesarean section surgery at University Hospital. Patients will be approached regarding interest in the study prior to hospital discharge.A trained Professional Research Assistant or other provider will explain the study and obtain informed consent from prospective participants. After consent, demographics and the best contact information will be collected from those enrolled patients who indicate they are interested in completing the surveys after their hospital discharge.
The investigators expect 44 patients to complete all four weekly surveys and define the intent-to-treat sample as patients who complete one or more surveys (providing at least one observation to be used in analyses). To conservatively allow for increased variability due to attrition, 54 patients will be randomized equally electronically to intervention (prescription tool) or no intervention (prescription as usual). The investigators will use an electronic randomization scheme created so that the principal investigator and statistician can remain blind to assignment.
In the intervention group (Arm 2), at the time of writing the prescription for a patient, the provider will be informed that a patient may be considered for a lower post-discharge opioid dose (No opioids for patients who did not take any opioids in the last 24 hours, and 10 oxycodone 5mg tablets, for patients having taken equal or less than 22.5 MME (morphine milligram equivalent), e.g. 1-3 oxycodone 5mg tablets in the last 24 hours.) In the control group (Arm 1), providers will receive a message to consider prescribing the usual medications for pain management after discharge. Final dosing decisions and drug choices will remain at the discretion of the treating provider and decisions will be tracked. For this pilot study, the provider information (best practice alert - BPA) will be operationalized via a written recommendation on paper handed to the provider by study staff in a sealed envelope that the provider will be asked to open and read. Alternatively the BPA may be presented electronically using a screen. Providers will be asked to acknowledge that they read the BPA by closing the window or opening the envelope.
One week after hospital discharge interested patients will be contacted and asked to complete the first of four surveys. All communication will be available in English. Patients will be paid with a $10 gift card or money order equivalent to complete the study assessments using REDCap at each of the four weekly follow-up time points ($40 total). All enrolled patients will complete the weekly post-discharge surveys within REDCap or hard copy if they do not have internet access.
The study team will contact all subjects ~2 weeks after discharge to ask about pain management and monitor the need for secondary prescriptions from providers to ensure that no significant under-prescription of opioid medications after surgery occurs.
The investigators will seek follow-up with providers about the usefulness and acceptability of the EHR-based intervention. Providers will be surveyed with a REDCap survey using a modified version of the GUIDES checklist, which provides a tool to improve the successful use of guideline-based computerized clinical decision support.
- Conditions
- Opioid Use
- Being tested
- Arm 1 Prescription As Usual, Arm 2 Prescription Tool Intervention
- Keywords
- opioids
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Arm 1 Prescription As UsualOther
At the time of writing the discharge prescription for a patient the provider will receive a best practice alert (BPA) to consider prescribing the usual medications for pain management after discharge.
Arm 2 Prescription Tool InterventionOther
The best practice alert (BPA) Prescription Tool will only make a suggestion to the provider if the patient may be considered for a lower post-discharge opioid dose. Providers may still choose to prescribe a higher dose as clinically indicated.
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 Prescription As Usual | Placebo comparator | At the time of writing the discharge prescription for a patient the provider will receive a best practice alert (BPA) to consider prescribing the usual medications for pain management after discharge. Receives: Other: Arm 1 Prescription As Usual |
| Arm 2 Prescription Tool Intervention | Experimental | At the time of writing the discharge prescription for a patient the provider will be informed by the best practice alert (BPA) Prescription Tool that a patient may be considered for a lower post-discharge opioid dose (no opioids for patients who did not take any opioids in the last 24 hours, and 10 oxycodone 5mg tablets, for patients having taken less than 22.5 MME, e.g. 1-3 oxycodone 5mg tablets in the last 24 hours). Final dosing decisions and drug choices will remain at the discretion of the treating provider and decisions will be tracked. Receives: Other: Arm 2 Prescription Tool Intervention |
What is being measured
The primary outcome is the main question the study is designed to answer.
Prescribed Post-discharge Opioids
Prescribed post-discharge opioid doses in oral morphine equivalents from the electronic health record (EHR).
Measured: Date of admission to the hospital up to 60 days after the date of hospital discharge.
Secondary outcomes (8)
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 1
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Score as reported on the Week 1 study survey. The Scale consists of 8 questions; each question in the Scale has five response options ranging in value from one to five, e.g., Not at all (1), A little bit (2), Somewhat (3), Quite a bit (4), Very much (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 8; the highest possible raw score is 40, with a lower score indicating a better outcome/less pain interference. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: One week after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 2
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Score as reported on the Week 2 study survey. The Scale consists of 8 questions; each question in the Scale has five response options ranging in value from one to five, e.g., Not at all (1), A little bit (2), Somewhat (3), Quite a bit (4), Very much (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 8; the highest possible raw score is 40, with a lower score indicating a better outcome/less pain interference. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: Two weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 3
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Score as reported on the Week 3 study survey. The Scale consists of 8 questions; each question in the Scale has five response options ranging in value from one to five, e.g., Not at all (1), A little bit (2), Somewhat (3), Quite a bit (4), Very much (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 8; the highest possible raw score is 40, with a lower score indicating a better outcome/less pain interference. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: Three weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 4
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Score as reported on the Week 4 study survey. The Scale consists of 8 questions; each question in the Scale has five response options ranging in value from one to five, e.g., Not at all (1), A little bit (2), Somewhat (3), Quite a bit (4), Very much (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 8; the highest possible raw score is 40, with a lower score indicating a better outcome/less pain interference. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: Four weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 1
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Score as reported on the Week 1 study survey. The Scale consists of 3 questions; each question in the Scale has five response options ranging in value from one to five, e.g., No pain (1), Mild (2), Moderate (3), Severe (4), Very Severe (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 3; the highest possible raw score is 15, with a lower score indicating a better outcome/less pain intensity. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: One week after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 2
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Score as reported on the Week 2 study survey. The Scale consists of 3 questions; each question in the Scale has five response options ranging in value from one to five, e.g., No pain (1), Mild (2), Moderate (3), Severe (4), Very Severe (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 3; the highest possible raw score is 15, with a lower score indicating a better outcome/less pain intensity. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: Two weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 3
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Score as reported on the Week 3 study survey. The Scale consists of 3 questions; each question in the Scale has five response options ranging in value from one to five, e.g., No pain (1), Mild (2), Moderate (3), Severe (4), Very Severe (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 3; the highest possible raw score is 15, with a lower score indicating a better outcome/less pain intensity. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: Three weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 4
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Score as reported on the Week 4 study survey. The Scale consists of 3 questions; each question in the Scale has five response options ranging in value from one to five, e.g., No pain (1), Mild (2), Moderate (3), Severe (4), Very Severe (5). To find the total raw score sum the values of the response to each question. The lowest possible raw score is 3; the highest possible raw score is 15, with a lower score indicating a better outcome/less pain intensity. Raw scores are then translated into a T-score for each participant. The T-score rescales the raw score into a standardized score with a mean of 50 and a standard deviation (SD) of 10.
Measured: Four weeks after hospital discharge date.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Aug 2019
- Study start24 Oct 2019
- Primary completion13 Jan 2021
- Study completion13 Jan 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Opioid UseStudies of the same condition, open and under way.
- More trials run by University of Colorado, DenverThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- The investigators will test this tool prospectively for Cesarean section patients anticipated to use about half or less of the usually prescribed amount of opioid pain pills randomized equally to prescription tool intervention or no intervention (prescription as usual).
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 57 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Colorado, Denver
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Drug Abuse (NIDA)
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04043143
- Sponsor's protocol ID
- 18-2098
- Other IDs
- K23DA040923
- Status last verified
- Sep 2021
- First submitted
- 18 Apr 2019
- Last updated
- 27 Oct 2021
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Data may be shared with other researchers as required by some journals or as requested by qualified investigators as determined by the study PI. However, all names and any other information that identifies research subjects will always be kept confidential and will not be shared.
Publications
Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer CJ, Binswanger IA. Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery. PLoS One. 2016 Jan 29;11(1):e0147972. doi: 10.1371/journal.pone.0147972. eCollection 2016.
PubMed 26824844Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, Clancy CR, Hopp SB, Ecker JL, Ende H, Grewe K, Raposo Corradini B, Schoenfeld RE, Sankar K, Day LJ, Harris L, Booth JL, Flood P, Bauer ME, Tsen LC, Landau R, Leffert LR. Patterns of Opioid Prescription and Use After Cesarean Delivery. Obstet Gynecol. 2017 Jul;130(1):29-35. doi: 10.1097/AOG.0000000000002093.
PubMed 28594763Chen EY, Marcantonio A, Tornetta P 3rd. Correlation Between 24-Hour Predischarge Opioid Use and Amount of Opioids Prescribed at Hospital Discharge. JAMA Surg. 2018 Feb 21;153(2):e174859. doi: 10.1001/jamasurg.2017.4859. Epub 2018 Feb 21.
PubMed 29238810Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies--tackling the opioid-overdose epidemic. N Engl J Med. 2014 May 29;370(22):2063-6. doi: 10.1056/NEJMp1402780. Epub 2014 Apr 23. No abstract available.
PubMed 24758595Bartels K, Fernandez-Bustamante A, McWilliams SK, Hopfer CJ, Mikulich-Gilbertson SK. Long-term opioid use after inpatient surgery - A retrospective cohort study. Drug Alcohol Depend. 2018 Jun 1;187:61-65. doi: 10.1016/j.drugalcdep.2018.02.013. Epub 2018 Mar 27.
PubMed 29627407Bartels K, Binswanger IA, Hopfer CJ. Sources of Prescription Opioids for Nonmedical Use. J Addict Med. 2016 Mar-Apr;10(2):134. doi: 10.1097/ADM.0000000000000192. No abstract available.
PubMed 26985647Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr. Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. J Am Coll Surg. 2018 Jun;226(6):996-1003. doi: 10.1016/j.jamcollsurg.2017.10.012. Epub 2017 Nov 30.
PubMed 29198638National Institutes of Health, PROMIS tools for pain intensity and pain interference. http://www.healthmeasures.net/explore-measurement-systems/promis Last accessed on 03/02/2018.
Study at a glance
From the registry record, last updated by the sponsor on 27 Oct 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- 24-hour Oral Morphine Equivalent Based Opioid Prescribing After Surgery
- ClinicalTrials.gov ID
- NCT04043143
- Acronym / sponsor ID
- 18-2098
- Conditions
- Opioid Use
- Keywords
- opioids
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 57 participants (actual)
- Lead sponsor
- University of Colorado, DenverUniversity, hospital or other
- Collaborators
- National Institute on Drug Abuse (NIDA)
- Study start
- 24 Oct 2019 (actual)
- Primary completion
- 13 Jan 2021 (actual)
- Study completion
- 13 Jan 2021 (actual)
- First posted
- 2 Aug 2019 (actual)
- Results
- Posted 27 Oct 2021
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators will utilize the electronic health record to individualize pain therapy in surgical patients after hospital discharge using last 24-hour opioid intake as the decision variable for the amount of opioid pain pills prescribed. The preliminary data indicate that current opioid prescription practice after surgery follows a "one size fits all" pattern. In-hospital opioid use 24 hours prior to discharge serves as a strong indicator to correctly estimate needs for analgesic medications at home. The investigators will test the hypothesis that this prescription estimation tool will enable providers to write need-based prescriptions based on each patient's' 24-hour prior-to-discharge opioid use. The investigators will test this tool prospectively for patients after Cesarean section who are anticipated to use about half or less of the usually prescribed amount of opioid pain pills after discharge randomized equally to prescription tool intervention or no intervention (prescription as usual).
Detailed description
Prescription opioid overdose has emerged as a leading cause of death in the general population. Opioid-based therapy represents a corner-stone of post-operative pain management. With increasing emphasis on robust pain therapy, sales of opioid medications have increased four-fold in the last decade. Parallel to this rise, opioid-associated deaths have also quadrupled. The investigators have shown that long-term opioid use occurs in up to 22% of patients following surgery. Over-prescribed opioids after surgery can create a reservoir of opioids that become available for non-medical use. Effective strategies to maximize non-opioid pain therapy and to limit such a reservoir are lacking. Thus, there is an urgent need to individualize post-operative pain therapy and reduce reliance on opioids.
Converting knowledge on actual need for opioid pain medications after surgery into tangible benefits can prevent over-prescription of opioids that become available for non-medical use. The objective of this study is to prescribe pain medications after surgery in a patient-centered fashion. The investigators will use the average amount of opioid medications (in oral morphine equivalents - OME) taken in the last 24 hours prior to discharge to inform and design a clinical decision support tool. This tool will reduce the amount of opioid medications prescribed while maintaining patient post-operative pain control. The calculated "last 24 hour OME dose" will be applied to generate a recommendation for the prescription of a cumulative opioid dose that will be shared with the provider when the post-discharge pain medication is made, e.g. via displaying the last 24-hour opioid use in the electronic health record (EHR). The rationale is that testing of such a decision-making tool will lay the groundwork to translate the findings of this project into more secure and efficient opioid prescribing practices to a system-wide level. Upon completion, the investigators expect to have developed an effective decision-making tool to help providers estimate required pain medication following patient discharge.
The investigators will perform a randomized clinical trial (RCT) of an Electronic Health Record (EHR)-based recommendation to prescribe opioids at discharge according to the recorded last 24-hour inpatient use according to current recommendations and evaluate its effect on the amount of opioids prescribed as well as pain control after discharge.
Using the University of Colorado Hospital Epic/Clarity database, the investigators will continuously identify all patients who underwent Cesarean section surgery at University Hospital. Patients will be approached regarding interest in the study prior to hospital discharge.A trained Professional Research Assistant or other provider will explain the study and obtain informed consent from prospective participants. After consent, demographics and the best contact information will be collected from those enrolled patients who indicate they are interested in completing the surveys after their hospital discharge.
The investigators expect 44 patients to complete all four weekly surveys and define the intent-to-treat sample as patients who complete one or more surveys (providing at least one observation to be used in analyses). To conservatively allow for increased variability due to attrition, 54 patients will be randomized equally electronically to intervention (prescription tool) or no intervention (prescription as usual). The investigators will use an electronic randomization scheme created so that the principal investigator and statistician can remain blind to assignment.
In the intervention group (Arm 2), at the time of writing the prescription for a patient, the provider will be informed that a patient may be considered for a lower post-discharge opioid dose (No opioids for patients who did not take any opioids in the last 24 hours, and 10 oxycodone 5mg tablets, for patients having taken equal or less than 22.5 MME (morphine milligram equivalent), e.g. 1-3 oxycodone 5mg tablets in the last 24 hours.) In the control group (Arm 1), providers will receive a message to consider prescribing the usual medications for pain management after discharge. Final dosing decisions and drug choices will remain at the discretion of the treating provider and decisions will be tracked. For this pilot study, the provider information (best practice alert - BPA) will be operationalized via a written recommendation on paper handed to the provider by study staff in a sealed envelope that the provider will be asked to open and read. Alternatively the BPA may be presented electronically using a screen. Providers will be asked to acknowledge that they read the BPA by closing the window or opening the envelope.
One week after hospital discharge interested patients will be contacted and asked to complete the first of four surveys. All communication will be available in English. Patients will be paid with a $10 gift card or money order equivalent to complete the study assessments using REDCap at each of the four weekly follow-up time points ($40 total). All enrolled patients will complete the weekly post-discharge surveys within REDCap or hard copy if they do not have internet access.
The study team will contact all subjects ~2 weeks after discharge to ask about pain management and monitor the need for secondary prescriptions from providers to ensure that no significant under-prescription of opioid medications after surgery occurs.
The investigators will seek follow-up with providers about the usefulness and acceptability of the EHR-based intervention. Providers will be surveyed with a REDCap survey using a modified version of the GUIDES checklist, which provides a tool to improve the successful use of guideline-based computerized clinical decision support.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
- Model description
- The investigators will test this tool prospectively for Cesarean section patients anticipated to use about half or less of the usually prescribed amount of opioid pain pills randomized equally to prescription tool intervention or no intervention (prescription as usual).
| Arm | Type | Receives |
|---|---|---|
| Arm 1 Prescription As Usual | Placebo comparator | Other: Arm 1 Prescription As UsualAt the time of writing the discharge prescription for a patient the provider will receive a best practice alert (BPA) to consider prescribing the usual medications for pain management after discharge. |
| Arm 2 Prescription Tool Intervention | Experimental | Other: Arm 2 Prescription Tool InterventionAt the time of writing the discharge prescription for a patient the provider will be informed by the best practice alert (BPA) Prescription Tool that a patient may be considered for a lower post-discharge opioid dose (no opioids for patients who did not take any opioids in the last 24 hours, and 10 oxycodone 5mg tablets, for patients having taken less than 22.5 MME, e.g. 1-3 oxycodone 5mg tablets in the last 24 hours). Final dosing decisions and drug choices will remain at the discretion of the treating provider and decisions will be tracked. |
Who may qualify
- Ages
- 18 to 60 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Women ages at least 18 years of age having undergone Cesarean section surgery at the University of Colorado Hospital are eligible.
- Willingness to complete weekly surveys for 4 weeks after discharge.
- Anticipated to need half or less of the usually prescribed amount of opioids based on the amount of opioids taken in the last 24 hours prior to the opioid medication being written for discharge (only patients who took 22.5 MME or less opioids in the last 24 hours prior to the day of discharge will be eligible for this study).
Key exclusion criteria (7 listed)
- Patients under the age of 18 years.
- Patients returning to institutional settings (e.g. prison, jail, mental health facility).
- Pregnant women (patients will be approached after their C-section).
- Decisionally challenged patients.
- Blind or illiterate patients.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Arm 1 Prescription As UsualAt the time of writing the discharge prescription for a patient the provider will receive a best practice alert (BPA) to consider prescribing the usual medications for pain management after discharge. | Other | Arm 1 Prescription As Usual |
| Arm 2 Prescription Tool InterventionThe best practice alert (BPA) Prescription Tool will only make a suggestion to the provider if the patient may be considered for a lower post-discharge opioid dose. Providers may still choose to prescribe a higher dose as clinically indicated. | Other | Arm 2 Prescription Tool Intervention |
Primary outcome
Prescribed Post-discharge Opioids
Time frame: Date of admission to the hospital up to 60 days after the date of hospital discharge.
Prescribed post-discharge opioid doses in oral morphine equivalents from the electronic health record (EHR).
8 secondary outcomes
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 1
Time frame: One week after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 2
Time frame: Two weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 3
Time frame: Three weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Week 4
Time frame: Four weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 1
Time frame: One week after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 2
Time frame: Two weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 3
Time frame: Three weeks after hospital discharge date.
Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Week 4
Time frame: Four weeks after hospital discharge date.
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Oct 2021.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 26824844Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer CJ, Binswanger IA. Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery. PLoS One. 2016 Jan 29;11(1):e0147972. doi: 10.1371/journal.pone.0147972. eCollection 2016.
- Background: PubMed 28594763Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, Clancy CR, Hopp SB, Ecker JL, Ende H, Grewe K, Raposo Corradini B, Schoenfeld RE, Sankar K, Day LJ, Harris L, Booth JL, Flood P, Bauer ME, Tsen LC, Landau R, Leffert LR. Patterns of Opioid Prescription and Use After Cesarean Delivery. Obstet Gynecol. 2017 Jul;130(1):29-35. doi: 10.1097/AOG.0000000000002093.
- Background: PubMed 29238810Chen EY, Marcantonio A, Tornetta P 3rd. Correlation Between 24-Hour Predischarge Opioid Use and Amount of Opioids Prescribed at Hospital Discharge. JAMA Surg. 2018 Feb 21;153(2):e174859. doi: 10.1001/jamasurg.2017.4859. Epub 2018 Feb 21.
- Background: PubMed 24758595Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies--tackling the opioid-overdose epidemic. N Engl J Med. 2014 May 29;370(22):2063-6. doi: 10.1056/NEJMp1402780. Epub 2014 Apr 23. No abstract available.
- Background: PubMed 29627407Bartels K, Fernandez-Bustamante A, McWilliams SK, Hopfer CJ, Mikulich-Gilbertson SK. Long-term opioid use after inpatient surgery - A retrospective cohort study. Drug Alcohol Depend. 2018 Jun 1;187:61-65. doi: 10.1016/j.drugalcdep.2018.02.013. Epub 2018 Mar 27.
- Background: PubMed 26985647Bartels K, Binswanger IA, Hopfer CJ. Sources of Prescription Opioids for Nonmedical Use. J Addict Med. 2016 Mar-Apr;10(2):134. doi: 10.1097/ADM.0000000000000192. No abstract available.
- Background: PubMed 29198638Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr. Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. J Am Coll Surg. 2018 Jun;226(6):996-1003. doi: 10.1016/j.jamcollsurg.2017.10.012. Epub 2017 Nov 30.
- BackgroundNational Institutes of Health, PROMIS tools for pain intensity and pain interference. http://www.healthmeasures.net/explore-measurement-systems/promis Last accessed on 03/02/2018.
- Individual participant dataSharing planned: No. Data may be shared with other researchers as required by some journals or as requested by qualified investigators as determined by the study PI. However, all names and any other information that identifies research subjects will always be kept confidential and will not be shared.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Arm 1 Prescription As Usual and Arm 2 Prescription Tool Intervention in people with Opioid Use, run by University of Colorado, Denver at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 27 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 27 Oct 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Prescribed Post-discharge Opioids (time frame: Date of admission to the hospital up to 60 days after the date of hospital discharge.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04043143, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Oct 2021.