De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions

取消阿片类药物的使用并在拔牙后实施最佳疼痛管理

• 批准号: 9438338
• 负责人: Shannon Gwin Mitchell
• 金额: $ 78.51万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9438338
• 关键词: Absence of pain sensation; Acetaminophen; Acute; Adverse effects; Analgesics; Appointment; Automobile Driving; Centers for Disease Control and Prevention (U.S.); Clinical; Cluster randomized trial; Consumption; Data; Decision Making; Dental; Dentists; Dose; Drug Monitoring; Drug Prescriptions; Education; Electronic Health Record; Elements; Epidemic; Evidence based practice; Goals; Incidence; Language; Medication Management; Methods; Morphine; Non-Steroidal Anti-Inflammatory Agents; Operative Surgical Procedures; Opioid; Opioid Analgesics; Overdose; Pain; Pain management; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Postoperative Pain; Postoperative Period; Provider; Public Health; Randomized; Recommendation; Recording of previous events; Reporting; Risk; Safety; Symptoms; Techniques; Testing; Time; United States; Visit; arm; chronic pain; clinical decision-making; comparative efficacy; disorder prevention; electronic data; evidence base; innovation; novel; opioid use; prescription opioid; programs; shared decision making; support tools; systematic review; third molar extraction; tool; trial design

Project Summary The primary objective of this project is to de-implement the use of opioid analgesics for the management of postoperative pain following dental extractions and to implement effective alternative pain management. We propose a cluster-randomized trial design in which dental practitioners will be randomly assigned to 1 of 3 conditions involving different implementation strategies. The first condition, Standard Practice, will serve as a control condition. The second condition will implement a clinical decision support (CDS) tool that will extract patient history and interface with the state prescription drug monitoring program to provide personalized recommendations for analgesic prescribing and offer language for discussing optimal, evidence-based non- opioid pain management with dental extraction patients. The third condition will involve an enhanced version of the CDS (CDS-E) that will also include information regarding optimal, evidence-based, non-opioid pain management delivered directly to the patient both before and following the dental extraction visit. We will examine opioid and non-opioid prescribing data from the electronic health record across study arms as well as other provider- and patient-focused outcomes using mixed methods.

项目摘要 该项目的主要目标是停止使用阿片类镇痛剂管理 拔牙术后疼痛，并实施有效的替代疼痛管理。我们 提出了一个集群随机试验设计，其中牙科医生将被随机分配到3个 涉及不同实施策略的条件。第一个条件，标准做法，将作为一个 控制条件第二个条件将实现临床决策支持（CDS）工具，该工具将提取 病人的历史和接口与国家处方药监测计划，以提供个性化的 镇痛药处方的建议，并提供讨论最佳的，基于证据的非 拔牙患者的阿片类药物疼痛管理。第三个条件将涉及一个增强版的 CDS（CDS-E）还将包括关于最佳、循证、非阿片类药物疼痛的信息 在拔牙访视之前和之后，直接向患者提供管理。我们将 检查研究组电子健康记录中的阿片类药物和非阿片类药物处方数据， 使用混合方法的其他以提供者和患者为中心的结果。