Clinical Decision Support to Increase Use of Medications for Opioid Use Disorder

University of Colorado Denver (CU Denver)

Status: Not yet enrolling

Conditions: Supportive Care; Medication Abuse; Opioid Use Disorder; Harm Reduction

Treatments: Other: Medications for Opioid Use Disorder Pathway Clinical Decision Support (CDS)

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT06526286

R61DA057610 (U.S. NIH Grant/Contract)

24-1188 (Other Identifier)

Details and patient eligibility

About

The objective of this study is to evaluate the impact of clinical decision support (CDS) in the form of an alert to identify patients who may be at risk of opioid use disorder (OUD) and a clinical care pathway helping providers treating patients with opioid use disorder. The pathway provides health care providers with information and suggestions for screening and treatment of opioid use disorder, including treatment with medications. The 2022 Centers for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain recommends providers asses for and treat opioid use disorder using approved medications for opioid use disorder (MOUD). This project will randomize primary care providers at the clinic level to a control arm or intervention arm. The control arm will have access to the clinical care pathway, but will not be reminded to utilize the pathway when treating a patient with opioid use disorder. The intervention arm will receive a reminder nudge about the pathway. Buprenorphine (a medication used to treat opioid use disorder) prescribing behavior of providers and outcomes of patients will be examined based on medical records data collected during routine care. The study period will be approximately 18 months.

Enrollment: 200,000 estimated patients

Sex: All

Ages: 12 to 89 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Primary care encounter AND
• Current opioid prescription (not buprenorphine) and Active opioid medications over the last 90 days OR
• Documented as on local Pain Registry "Does the patient fit the criteria to be included on the Pain Registry?" OR
• Has active problem list diagnosis of long-term (current) use of opiate analgesic OR
• Is taking >=90 morphine milligram equivalents (MME) per day OR
• Prior positive toxicology screen for illicit drugs OR
• Diagnosis of opioid use disorder

Exclusion criteria

• Active cancer diagnosis in the last 1 year
• Hospice care/palliative care order
• Sickle cell disease diagnosis

Trial design

200,000 participants in 2 patient groups

Usual Care

Description:

Control group to enable tracking of temporal changes in prescribing. Providers will not see any alert.

CDS Notification

Description:

Providers will see a clinical decision support tool within the electronic health record when treating a patient at risk for opioid use disorder to encourage the provider to use a clinical care pathway to assess for opioid use disorder and when applicable, treat opioid use disorder with buprenorphine. Smart text will also be available in the electronic health record so that the provider can easily document screening and treatment discussions with the patient.

Treatment:

Other: Medications for Opioid Use Disorder Pathway Clinical Decision Support (CDS)