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Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care : Protocol for a randomized controlled trial Klimas, Jan; Hamilton, Michee-Ana; Carney, Greg; Cooper, Ian R.; Croteau, Nicole; Dong, Huiru; Dormuth, Colin; Maclure, Malcolm; Socias, M. Eugenia; Ti, Lianping; et al.

Abstract

Background: Opioid analgesics are frequently initiated for chronic and acute pain despite weak evidence of benefit, although prescribing rates of some analgesics decreased in the context of the epidemic. In some populations, up to a quarter of opioid naïve persons prescribed opioids for noncancer pain develop prescription opioid use disorder (OUD). Audit and feedback interventions rely on constructive use of routinely collected data to align professional behaviours and clinical practice with best evidence. These interventions have been shown to help reduce inappropriate initiation. However, effectiveness and acceptability of individualized “portraits” of physicians’ prescribing patterns, to reduce inappropriate initiation of opioid analgesics to opioid naïve persons, have not been evaluated. Methods: REDONNA is a mixed-methods randomized study testing the effectiveness of individualized prescribing Portraits to reduce inappropriate initiation of opioid analgesics. This intervention to improve safety of opioid prescribing in primary care in British Columbia (BC), Canada involves mailing individual prescribing portraits to an ‘early group’ of 2604 family physicians, followed in six months by a mailing to 2553 family physicians in the ‘delayed group’. Primary outcome is number of new opioid prescriptions initiated in opioid naïve people, measured using administrative data from a centralized medication monitoring database covering all prescription opioids dispensed from BC community pharmacies. Secondary endpoints will compare prescribing impact between the two groups. A qualitative sub-study will examine feasibility among a purposive sample of physicians and patients. Discussion: This trial provides important evidence on the intervention’s potential to steer policy and practice on inappropriate opioid analgesics initiation.

Item Metadata

Title
Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care : Protocol for a randomized controlled trial
Creator
Klimas, Jan; Hamilton, Michee-Ana; Carney, Greg; Cooper, Ian R.; Croteau, Nicole; Dong, Huiru; Dormuth, Colin; Maclure, Malcolm; Socias, M. Eugenia; Ti, Lianping; Wood, Evan; McCracken, Rita
Contributor
British Columbia Centre on Substance Use; St. Paul's Hospital (Vancouver, B.C.)
Publisher
Elsevier
Date Issued
2021-05-31
Description
Background: Opioid analgesics are frequently initiated for chronic and acute pain despite weak evidence of benefit, although prescribing rates of some analgesics decreased in the context of the epidemic. In some populations, up to a quarter of opioid naïve persons prescribed opioids for noncancer pain develop prescription opioid use disorder (OUD). Audit and feedback interventions rely on constructive use of routinely collected data to align professional behaviours and clinical practice with best evidence. These interventions have been shown to help reduce inappropriate initiation. However, effectiveness and acceptability of individualized “portraits” of physicians’ prescribing patterns, to reduce inappropriate initiation of opioid analgesics to opioid naïve persons, have not been evaluated. Methods: REDONNA is a mixed-methods randomized study testing the effectiveness of individualized prescribing Portraits to reduce inappropriate initiation of opioid analgesics. This intervention to improve safety of opioid prescribing in primary care in British Columbia (BC), Canada involves mailing individual prescribing portraits to an ‘early group’ of 2604 family physicians, followed in six months by a mailing to 2553 family physicians in the ‘delayed group’. Primary outcome is number of new opioid prescriptions initiated in opioid naïve people, measured using administrative data from a centralized medication monitoring database covering all prescription opioids dispensed from BC community pharmacies. Secondary endpoints will compare prescribing impact between the two groups. A qualitative sub-study will examine feasibility among a purposive sample of physicians and patients. Discussion: This trial provides important evidence on the intervention’s potential to steer policy and practice on inappropriate opioid analgesics initiation.
Subject
opioid; quality improvement; health administrative data; randomized controlled trial
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2022-05-31
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0401213
URI
http://hdl.handle.net/2429/79182
Affiliation
Medicine, Faculty of; Non UBC; Anesthesiology, Pharmacology and Therapeutics, Department of; Family Practice, Department of; Medicine, Department of
Citation
Klimas, J., Hamilton, M.A., Carney, G., Cooper, I., Croteau, N.S., Dong, H., Dormuth, C., Maclure, M., Socías, M.E., Ti, L., Wood, E., McCracken, R. (2021) Individualized prescribing portraits to reduce inappropriate initiation of prescription opioid analgesics to opioid naïve patients in primary care: Randomized controlled trial. Contemp Clin Trials, 107: 106462
Publisher DOI
10.1016/j.cct.2021.106462
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International