De-Implementing Opioids for Dental Extractions (DIODE)

HealthPartners Institute

Status: Completed

Conditions: Tooth Extraction

Treatments: Other: Clinical Decision Support; Other: Patient education

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT03584789

U01DE027441 (U.S. NIH Grant/Contract)

A17-013

Details and patient eligibility

About

The overarching goal of this project is to de-implement the reliance on opioid analgesics and to implement reliance on non-opioid analgesics to manage postoperative pain following dental extractions. Using a prospective, provider-level, 3-arm cluster randomized trial design, the investigators will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients.

Full description

The primary objective of this project is to de-implement the use of opioid analgesics for the management of postoperative pain following dental extractions and to implement effective alternative pain management. The investigators propose a cluster-randomized trial design in which dental practitioners will be randomly assigned to 1 of 3 conditions involving different implementation strategies. The first condition, Standard Practice, will serve as a control condition. The second condition will implement a clinical decision support (CDS) tool that will extract patient history and interface with the state prescription drug monitoring program to provide personalized recommendations for analgesic prescribing and offer language for discussing optimal, evidence-based non-opioid pain management with dental extraction patients. The third condition will involve an enhanced version of the CDS (CDS-E) that will also include information regarding optimal, evidence-based, non-opioid pain management delivered directly to the patient both before and following the dental extraction visit. The investigators will examine opioid and non-opioid prescribing data from the electronic health record across study arms as well as other provider- and patient-focused outcomes using mixed methods.

Enrollment: 5,722 patients

Sex: All

Ages: 16+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

PATIENTS

Inclusion Criteria:

• Have a dental extraction of a permanent teeth performed by an eligible HealthPartners provider during the intervention period

Exclusion Criteria:

• Patients who have opted out of research at HealthPartners
• Meet above age criteria

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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5,722 participants in 3 patient groups

Standard Practice

No Intervention group

Description:

The patients in this arm were part of usual care with their dental provider.

Clinical Decision Support

Experimental group

Description:

A clinical decision support system designed to assist dentists in providing optimal pain management for patients without resorting to opioids when a non-opioid alternative would suffice. It provides pertinent clinical information to the dentist, including point-of-care access to the Prescription Drug Monitoring Program.

Treatment:

Other: Clinical Decision Support

Clinical Decision Support + Education

Experimental group

Description:

Patient education regarding pain management before and after dental extraction, including information about the risks and benefits of various strategies.

Treatment:

Other: Clinical Decision Support

Other: Patient education