Health Behavior Clinical Trial
Official title:
An Opioid Prescribing Nudge: Leveraging Behavioral Economics to Reduce Opioid Harms Within Health Systems
Analyze baseline concurrent opioid prescribing metrics at the individual prescriber level in
the Duke Health System on the identified three main outcome measures.
Test the impact of reports on opioid prescriber behaviors with the following primary
measures: number of prescriptions with concurrent benzo within reporting period, number of
prescriptions with concurrent muscle relaxants within reporting period, and number of
encounters with naloxone prescriptions for patients with any opioid-related diagnosis within
reporting period.
Create a blueprint to implement the concurrent opioid prescribing nudge intervention in other
settings.
The Concurrent Opioid Prescribing Nudge project intends to address multiple points within the
opioid-use cycle through the development of standardized and scalable reporting mechanisms to
provide social comparisons and feedback to physicians across the Duke Health System regarding
their concurrent and co- opioid, benzodiazepines, and muscle relaxant prescribing practices.
Concurrent are hereby defined as:
- writing a new opioid prescription for a patient with a benzodiazepine prescription
within the last 3 months,
- writing a new benzodiazepine prescription for a patient with a opioid prescription
within the last 3 months,
- writing a new muscle relaxant prescription for a patient with an opioid prescription
within the last 3 months,
- writing a new opioid prescription for a patient with muscle relaxant prescription within
the last 3 months, or
- writing a new prescription for both an opioid and benzodiazepine or opioid and muscle
relaxant.
The proposed project will leverage insights from behavioral economics to design informational
and social incentives to reduce concurrent practices and mitigate opioid harm. Opioid
prescribers (attending physicians, residents, and advanced practice providers) at
participating departments and clinics in the Duke Health System will be randomized to a
control or intervention arm. Over six month reporting periods beginning fall 2019, providers
in the intervention arms will receive monthly reports with their individual prescribing
patterns and comparison to peer prescribing patterns for the following measures: number of
prescriptions with concurrent opioid active prescriptions of opioid/ benzodiazepines, number
of prescriptions with concurrent opioid active prescriptions of opioid/muscle relaxants, and
number of missed opportunities to prescribe naloxone to patients with any opioid-related
diagnosis. The control arm will receive usual clinical education and feedback. Interventions
will be implemented at participating departments and clinics utilizing a stepped-wedge
timeline.
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