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Evaluation of audit and feedback to family physicians on prescribing of opioid analgesics to opioid-naïve patients : A pragmatic randomized delay trial McCracken, Rita; Narayan, Shawna; Maclure, Malcolm; Cooper, Ian R.; Cui, Zishan; Cullen, Walter; Dormuth, Colin; Hamilton, Michee-Ana; Nolan, Seonaid; Singer, Joel; Socías, M. Eugenia; Wong, Sabrina T.; Klimas, Jan

Abstract

Background: Exposure to opioid analgesics have historically raised concern for a risk of developing opioid use disorder. Prescriber audit-and-feedback interventions may reduce opioid prescribing, but some studies have shown detrimental effects for current users. We examined the effectiveness of an audit and feedback intervention, named Portrait, to reduce initiation of opioid analgesics among opioid-naïve patients experiencing pain. Methods: REDONNA was a single-blinded, two-arm (Early vs Delayed mailing) randomized trial of a portrait for eligible family physicians (FPs) in British Columbia (BC), Canada. The primary outcome was the change in the number of initiations of opioid analgesic prescriptions written by FPs for acute/chronic pain management. We compared outcomes for a 6-month window before vs. after each mailed intervention, using differences in percent differences (DPD) with 95% confidence intervals (CI) and odds ratios (OR) from logistic regressions adjusted for clustering of patients by FP. Results: In the Early (n=2260) and Delayed (n=2156) groups, opioid initiations per month were the same in the Before (2.10 Early; 2.06 Delayed) and After (1.94 Early; 1.95 Delayed) windows. The DPD was -2.1% (CI: -4.4% to 0.3%), and ORs were: 0.98 (CI: 0.96 to 1.01) for any opioid, 0.97 (CI: 0.94 to 1.01) for codeine (62% of initiations), and 1.0 (CI: 0.97 to 1.07) for tramadol (25% of initiations). There were no differences in mean quantity of tablets, mean milligrams of morphine equivalents (MME), or mean number of days. Conclusion: Portrait had no impact on FPs’ rates of prescribing opioid analgesics to opioid-naïve patients experiencing pain.

Item Metadata

Title
Evaluation of audit and feedback to family physicians on prescribing of opioid analgesics to opioid-naïve patients : A pragmatic randomized delay trial
Creator
McCracken, Rita; Narayan, Shawna; Maclure, Malcolm; Cooper, Ian R.; Cui, Zishan; Cullen, Walter; Dormuth, Colin; Hamilton, Michee-Ana; Nolan, Seonaid; Singer, Joel; Socías, M. Eugenia; Wong, Sabrina T.; Klimas, Jan
Contributor
University of British Columbia. Centre for Health Services and Policy Research; Centre for Health Evaluation & Outcome Sciences; British Columbia Centre on Substance Use; Therapeutics Initiative (University of British Columbia)
Publisher
Elsevier
Date Issued
2023-10-05
Description
Background: Exposure to opioid analgesics have historically raised concern for a risk of developing opioid use disorder. Prescriber audit-and-feedback interventions may reduce opioid prescribing, but some studies have shown detrimental effects for current users. We examined the effectiveness of an audit and feedback intervention, named Portrait, to reduce initiation of opioid analgesics among opioid-naïve patients experiencing pain. Methods: REDONNA was a single-blinded, two-arm (Early vs Delayed mailing) randomized trial of a portrait for eligible family physicians (FPs) in British Columbia (BC), Canada. The primary outcome was the change in the number of initiations of opioid analgesic prescriptions written by FPs for acute/chronic pain management. We compared outcomes for a 6-month window before vs. after each mailed intervention, using differences in percent differences (DPD) with 95% confidence intervals (CI) and odds ratios (OR) from logistic regressions adjusted for clustering of patients by FP. Results: In the Early (n=2260) and Delayed (n=2156) groups, opioid initiations per month were the same in the Before (2.10 Early; 2.06 Delayed) and After (1.94 Early; 1.95 Delayed) windows. The DPD was -2.1% (CI: -4.4% to 0.3%), and ORs were: 0.98 (CI: 0.96 to 1.01) for any opioid, 0.97 (CI: 0.94 to 1.01) for codeine (62% of initiations), and 1.0 (CI: 0.97 to 1.07) for tramadol (25% of initiations). There were no differences in mean quantity of tablets, mean milligrams of morphine equivalents (MME), or mean number of days. Conclusion: Portrait had no impact on FPs’ rates of prescribing opioid analgesics to opioid-naïve patients experiencing pain.
Subject
Opioid; Quality improvement; Health administrative data; Randomized controlled trial
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2024-10-17
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0438645
URI
http://hdl.handle.net/2429/87216
Affiliation
Applied Science, Faculty of; Medicine, Faculty of; Non UBC; Anesthesiology, Pharmacology and Therapeutics, Department of; Family Practice, Department of; Medicine, Department of; Nursing, School of; Population and Public Health (SPPH), School of
Citation
McCracken, R., Narayan, S., Maclure, M., Cooper, I., Cui, Z., Cullen, W., Dormuth, C., Hamilton, M.A., Nolan, S., Singer, J., Socías, M.E., Wong, S., Klimas, J. (2023) Evaluation of audit and feedback to family physicians on prescribing of opioid analgesics to opioid-naïve patients: A pragmatic randomized delay trial. Contemporary Clin Trials, (134):107354
Publisher DOI
10.1016/j.cct.2023.107354
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Graduate
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International