Evaluation of Clinical Decision Support in Opioid Tapering
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Opioid Tapering Pathway Clinical Decision Support (CDS).
- Who it may be relevant to
- Registry conditions: Medication Abuse, Harm Reduction, Opioid Use Disorder, Opioid Prescribing. Basic parameters: 12 years — 89 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Center list to be confirmed — check the primary protocol.
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
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.
Interventions
- Other Opioid Tapering Pathway Clinical Decision Support (CDS)
Clinical 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.
Primary outcome measures
- Percentage of encounters tapering within CDC guidelines [Time frame: 18 months]
Secondary outcome measures (3)
- Clinical decision support (CDS) acceptance rate [Time frame: 18 months]
- Subsequent opioid overdose/poisoning rates [Time frame: 6 months after taper encounter]
- Health care utilization [Time frame: 6 months after taper encounter]
Eligibility criteria
Inclusion Criteria: Primary care patients being tapered from an opioid. Tapering patients:
- 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
Exclusion criteria
- 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
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Observational model
- Cohort
Study locations
Center list to be confirmed — check the primary protocol.
Identifiers
NCT: NCT06527079 · 24-1193 · 24-1193 · R61DA057610