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The objective of this study is to design, implement, and pilot test a multi-faceted intervention to support safer opioid prescribing, self-administration, and monitoring and reduce persistent opioid use and opioid use disorder for patients transitioning to the community setting after major orthopedic surgery. The multi-faceted intervention includes: 1) communication with outpatient providers and counseling of patients and caregivers at hospital discharge; 2) standardized opioid prescribing discharge order sets for each type of surgery; 3) an outpatient pain management follow-up visit embedded within routine post-operative care for managing pain and opioid use, and 4) a mobile patient-reported outcomes application for assessing pain, function, and possible development of opioid use disorder (OUD). The primary outcome will be persistent opioid use (in the 6 months after surgery) based on state-wide prescription data. Secondary outcomes will include the total morphine-equivalent dose of opioids prescribed at discharge; total post-operative opioids dispensed in the 6 months after surgery; and self-reported opioid misuse, pain and function 90 and 180 days after surgery.
Full description
In this study, we will enroll patients who are both opioid-naïve and non-naïve who have undergone orthopedic surgery. To minimize contamination and best evaluate implementation, we will conduct a before-after study. The intervention will consist of four main components: 1) pharmacist-led discharge counseling and communication, 2) discharge order sets, 3) post-discharge pain management follow-up visits; and 4) a patient engagement pain management app. The intervention will last for 6 months following hospital discharge. We plan to enroll 270 patients over a 6-month period to demonstrate the feasibility of the intervention and provide reasonable precision on an effect size to inform power calculations on a subsequent larger scale clinical trial. During implementation, we will measure intervention fidelity and conduct qualitative interviews of stakeholders regarding facilitators and barriers to implementation. Throughout the study, we will engage a patient-family advisory council, other stakeholders, and a Steering Committee and Working Group to guide development and refinement of the intervention, execution of the implementation and evaluation plan, and the communication plan.
Specific Aims:
In the first 3 months of the study, patients will be assigned to usual care, including 1) multimodal analgesia after surgery; 2) unit-based pharmacists as available to monitor the appropriateness of inpatient medication orders, including opioids; 3) the standard discharge medication reconciliation module in the electronic health record (EHR) that compares preadmission and current inpatient medications to facilitate writing of safe medication orders; 4) general guidelines to limit the dose and duration of discharge opioids and to council patients about tapering opioids at home and to stop them by 4-6 weeks post-operatively unless instructed otherwise; and 5) standard follow-up in the outpatient orthopedics clinic within a time frame judged to be appropriate by each inpatient team. In months 4-6 of the study, patients will be assigned to the intervention. The intervention, which we will refer to as MOPP, will consist of four complementary components, as explained below. Each of these is in addition to usual care, as described above.
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204 participants in 2 patient groups
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Sarah M Corey, PhD; Richard D Urman, MD
Data sourced from clinicaltrials.gov
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