The Effect of Informative Letters on the Prescription and Receipt of Opioids

Abdul Latif Jameel Poverty Action Lab

Status: Withdrawn

Conditions: Delivery of Health Care; Economics; Prescribing; Health Expenditures; Fraud; Centers for Medicare and Medicaid Services (U.S.)

Treatments: Other: Patient Consequences Letter; Other: Prescriber Consequences Letter

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT03202745

JPAL-LETTERS-OPIOIDS

Details and patient eligibility

About

Inappropriate prescribing exposes patients to health risks and results in wasteful public expenditures. This study will evaluate an approach to fighting abusive prescription: sending letters to suspected potentially inappropriate prescribers warning them that they are outliers compared to their peers and have been flagged for review. The study will target high prescribers of opioids in the Schedule II controlled substances class. Two types of letters will be tested: one focusing on the health consequences of inappropriate prescribing for patients, and the other focusing on the consequences for prescribers including e.g. potential administrative actions. Using claims data, the investigators will assess the effect of the letters on prescribing of opioids, receipt of opioids by patients, substitution behavior by prescribers and patients, and health outcomes of patients.

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Outlier with respect to prescribing of Schedule II opioids relative to peers, measured in prescription drug events (PDE), in 2014Q3-2015Q2 and 2015Q3-2016Q2
• Outlier with respect to prescribing of Schedule II opioids relative to peers, measured in 30-day equivalents, in 2014Q3-2015Q2 and 2015Q3-2016Q2

Exclusion criteria

• Deceased
• Fewer than 75 Schedule II Opioid PDE in 2015Q3-2016Q2
• Specialty listed as "Student in an Organized Health Care Education/Training Program"

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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0 participants in 3 patient groups

Control

No Intervention group

Description:

The control arm will not receive any communications as a result of this study.

Patient Consequences

Experimental group

Description:

The patient consequences arm prescribers receive an initial patient consequences letter followed by 2 followup letters at approximately 3 month intervals. The letters focus on the consequences of inappropriate prescribing for patients.

Treatment:

Other: Patient Consequences Letter

Prescriber Consequences

Experimental group

Description:

The prescriber consequences arm prescribers receive an initial prescriber consequences letter followed by 2 followup letters at approximately 3 month intervals. The letters focus on the consequences of inappropriate prescribing for prescribers.

Treatment:

Other: Prescriber Consequences Letter