Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial.
Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial.
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评估基于电子邮件的午睡以减少术后阿片类药物处方的有效性：随机对照试验的研究方案。
DOI：
10.1136/bmjopen-2022-061980
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发表时间：
2022-09-19
期刊：
影响因子：
2.9
通讯作者：
Watkins, Katherine E.
中科院分区：
文献类型：
--
作者：
Kirkegaard, Allison;Wagner, Zachary;Mariano, Louis T.;Martinez, Meghan C.;Yan, Xiaowei Sherry;Romanelli, Robert J.;Watkins, Katherine E.
手术患者通常在出院时处方更多的阿片类药物，而不是管理术后疼痛所需的药物。这些过量的阿片类药物增加了新的持续使用阿片类药物、阿片类药物引起的排便障碍和阿片类药物转移的风险。这项研究测试了两种行为轻推的有效性，一种是基于同伴行为，另一种是基于最佳实践指南，以减少过量的术后阿片类药物处方。本研究将在美国北方加州一个大型医疗保健系统内的19家医院进行。每家医院的三个外科专科（普通外科、骨科和妇产科）将随机分配至对照组或两个积极干预组之一。一种干预是基于禁令规范的理论，并向外科医生提供关于其术后阿片类药物处方的反馈，相对于其机构认可的处方指南。另一种干预措施借鉴了描述性规范的理论，并提供了与第一种干预措施类似的反馈，但使用同行的行为而不是指南作为外科医生处方行为的基准。干预措施将通过每月电子邮件提供。这两项干预措施将持续12个月。将使用经多重假设检验调整的四水平分层模型检验每种干预相对于对照组和相互之间的影响。使用行为推动而不是僵硬的政策变化使我们能够针对过度处方，而不会阻止临床医生使用他们的临床判断来解决患者疼痛。所有研究活动均已获得兰德人类受试者保护委员会（ID 2018-0988）的批准。调查结果将通过会议介绍、同行评审出版物和社交媒体账户传播。NCT 05070338。
Surgical patients are commonly prescribed more opioids at discharge than needed to manage their postoperative pain. These excess opioids increase the risks of new persistent opioid use, opioid-induced ventilatory impairment and opioid diversion. This study tests the effectiveness of two behavioural nudges, one based on peer behaviour and one based on best practice guidelines, in reducing excessive postoperative opioid prescriptions. The study will be conducted at 19 hospitals within a large healthcare delivery system in northern California, USA. Three surgical specialties (general surgery, orthopaedic surgery and obstetric/gynaecological surgery) at each hospital will be randomised either to a control group or to one of two active intervention arms. One intervention is grounded in the theory of injunctive norms, and provides feedback to surgeons on their postoperative opioid prescribing relative to prescribing guidelines endorsed by their institution. The other intervention draws from the theory of descriptive norms, and provides feedback similar to the first intervention but using peers’ behaviour rather than guidelines as the benchmark for the surgeon’s prescribing behaviour. The interventions will be delivered by a monthly email. Both interventions will be active for twelve months. The effects of each intervention relative to the control group and to each other will be tested using a four-level hierarchical model adjusted for multiple hypothesis testing. Using behavioural nudges rather than rigid policy changes allows us to target excessive prescribing without preventing clinicians from using their clinical judgement to address patient pain. All study activities have been approved by the RAND Human Subjects Protection Committee (ID 2018-0988). Findings will be disseminated through conference presentations, peer-reviewed publications and social media accounts. NCT05070338.
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DOI：
10.1136/bmj.g1251
发表时间：
2014-02-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Clarke H;Soneji N;Ko DT;Yun L;Wijeysundera DN
通讯作者：
Wijeysundera DN
影响因子：
1
作者：
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Manuel, Solmaz P.
DOI：
10.5435/jaaosglobal-d-19-00109
发表时间：
2019-09-01
影响因子：
1.5
作者：
Choo, Kevin J.;Grace, Trevor R.;Hansen, Erik N.
通讯作者：
Hansen, Erik N.
影响因子：
9
作者：
Hill, Maureen V.;Stucke, Ryland S.;Barth, Richard J., Jr.
通讯作者：
Barth, Richard J., Jr.
DOI：
10.1016/j.jcjq.2020.04.004
发表时间：
2020-07
影响因子：
2.3
作者：
Fearon NJ;Benfante N;Assel M;Chesnut GT;Vickers A;Levine M;Broach V;Simon BA;Twersky R;Laudone VP
通讯作者：
Laudone VP