Reducing the default dispense quantity for new opioid analgesic prescriptions: study protocol for a cluster...

Area of Science:

• Public Health
• Health Services Research
• Clinical Informatics

Background:

• Rising opioid analgesic consumption correlates with increased opioid use disorder and overdose deaths.
• Reducing prescribed quantities for acute non-cancer pain can mitigate risks from leftover opioid medications.
• Electronic health record (EHR) default settings present a potential intervention point for modifying prescribing habits.

Purpose of the Study:

• To evaluate the effectiveness of modifying EHR default settings for new opioid analgesic prescriptions.
• To assess if defaulting to a 10-tablet dispense quantity reduces overall opioid prescribing for acute pain.

Main Methods:

• A prospective cluster randomized controlled trial involving 32 primary care sites and 4 emergency departments.
• Intervention arm: EHR modified to default new opioid prescriptions to 10 tablets; Control arm: no EHR modification.
• Patient-level data analyzed for initial prescription quantity, reorders, and health service utilization within 30 days.

Main Results:

• The primary outcome is the quantity of opioid analgesics prescribed in the initial prescription.
• Secondary outcomes include opioid analgesic reorders and health service utilization within 30 days.
• Analysis will compare outcomes between the intervention and control arms using a difference-in-differences approach.

Conclusions:

• Modifying EHR defaults to limit initial opioid analgesic prescription quantities is a feasible strategy.
• This intervention has the potential to reduce overall opioid prescribing and associated public health risks.
• Further analysis of collected data will determine the precise impact on prescribing patterns and patient outcomes.