Evaluation of Clinical Decision Support in Opioid Tapering

University of Colorado Denver (CU Denver)

Status: Not yet enrolling

Conditions: Prevention; Medication Abuse; Opioid Overdose; Opioid Use Disorder; Opioid Prescribing; Harm Reduction

Treatments: Other: Opioid Tapering Pathway Clinical Decision Support (CDS)

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT06527079

R61DA057610 (U.S. NIH Grant/Contract)

24-1193 (Other Identifier)

Details and patient eligibility

About

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.

Enrollment: 200,000 estimated patients

Sex: All

Ages: 12 to 89 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion 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

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 who may benefit from or is currently tapering opioid medications to encourage the provider to use a clinical care pathway that provides resources and decision support in tapering.

Treatment:

Other: Opioid Tapering Pathway Clinical Decision Support (CDS)