Background and Significance: This project addresses the research question “What is the comparative effectiveness of different health system strategies that aim to prevent unsafe opioid prescribing while ensuring access to non-opioid methods for pain management with the goal of reducing pain and improving patient function and quality-of-life outcomes, while reducing patient harm?” The project team will assess whether behavioral science-based interventions can “nudge” providers toward more evidence-based care for patients with acute non-cancer pain.
Aim 1) Among opioid naïve primary care patients with acute non-cancer pain, compare the effect of the provider-targeted behavioral interventions (opioid justification and provider comparison), individually and in combination, on initial opioid prescription, initial use of non-opioid management, and patient-reported pain and function.
Aim 2) Among primary care patients who receive initial opioid therapy for acute non-cancer pain, compare the effect of the two provider-targeted behavioral interventions, individually and in combination, on unsafe opioid prescribing and transition to chronic opioid therapy.
Aim 3) Assess provider and patient satisfaction and experience with the provider-targeted behavioral interventions.
Study Design: The project team plans a health system intervention to deliver provider-targeted behavioral interventions to prevent unsafe opioid prescribing, encourage non-opioid management, and improve pain and function in opioid-naïve patients with acute non-cancer pain.
Main Components: After implementing an evidence-based acute pain guideline in the EHR at each of clinics, the team will randomize the clinics to one of four intervention groups: 1) Usual Care; 2) Guideline + Opioid Justification; 3) Guideline + Provider Comparison; and 4) Guideline + Opioid Justification + Provider Comparison—all interventions delivered.
Study Population: The patient population will be 10,936 opioid naïve adults who present to clinic with acute uncomplicated musculoskeletal pain or headache.
Primary and Secondry Outcomes: The primary outcome measure will be unsafe opioid prescribing. Secondary outcomes will be receipt of an initial opioid prescription, non-opioid management, and, in 2,000 patients, patient-reported pain and function.
Analytic Plan: The study will use statistical models to test for differences in the primary and secondary outcomes among the four intervention groups.
The multidisciplinary research team will work closely with a stakeholder advisory committee comprised of patients, patient advocates, primary care providers, pain medicine specialists, payers, health system executives, experts in behavioral science, and regional and national organizations. Once completed, the project will provide evidence that health systems and other stakeholders need to implement interventions to prevent unsafe opioid prescribing.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.