Reducing Concurrent Opioid-Benzodiazepine Prescriptions

Walter Reed National Military Medical Center

Status: Unknown

Conditions: Adverse Drug Effect of Benzodiazepines; Adverse Drug Effect of Opioids

Treatments: Behavioral: E-mail Alert

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT03887247

REDUCE-CONCURRENT

Details and patient eligibility

About

The purpose of this effort is to use informative e-mails to improve the process of prescribing of opioids and benzodiazepines within the National Capital Region/Military Health System (NCR/MHS), with the aim of decreasing concurrent opioid and benzodiazepine prescribing.

Full description

The purpose of this effort is to use low-cost informative e-mails to improve the process of prescribing of opioids and benzodiazepines within the National Capital Region/Military Health System (NCR/MHS), with the aim of decreasing concurrent opioid and benzodiazepine prescribing. Both the VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain (2017) and the CDC Guideline for Prescribing Opioids for Chronic Pain (2016) strongly recommend against the concurrent use of opioids and benzodiazepines. Taken together, these drugs could cause respiratory depression, enhanced sedation, and death. The intervention population will be prescribers and primary care managers associated with patients who have recently received concurrent prescriptions of opioids and benzodiazepines. Using a randomized approach, we will allocate the NCR/MHS providers associated with patients with concurrent prescriptions for opioids and benzodiazepines to one of two conditions:

1. E-mail alert - A messaging approach, in which we will send encrypted emails to the patient's opioid and benzodiazepine prescriber(s) and primary care manager that identify the concurrent prescriptions and detail the patient's prescription history, inform them of the VA/DoD guideline and risk to patient, and provide action steps and relevant resources. When multiple providers are involved, the email message will also encourage coordination across providers and provide relevant contact information
2. As-Usual - An as-usual approach, in which providers are not sent messages. These providers can access patient information through the MHS Opioid Registry as before.

Enrollment: 2,234 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patient had an overlapping opioid-benzodiazepine prescription
• At least one of the patient's providers (opioid prescribers, benzodiazepine prescribers, and/or PCM) is in the NCR

Exclusion criteria

• Patient has a cancer diagnosis
• Patient is receiving palliative care
• Patient is under 18
• Patient was previously allocated to a study condition

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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2,234 participants in 2 patient groups

E-Mail Alert

Active Comparator group

Description:

Send email to the patient's opioid prescriber(s), benzodiazepine prescriber(s), and/or primary care manager.

Treatment:

Behavioral: E-mail Alert

As-Usual

No Intervention group

Description:

As-usual (no email) approach.