Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial

摘要 缺乏证据表明长期使用阿片类药物对非癌性疼痛和慢性疼痛有好处。 有大量的证据表明存在危害。去年，疾病控制和预防中心 (CDC)发布了“CDC慢性疼痛阿片类药物处方指南”，以鼓励安全 和阿片类药物的有效替代品，当患者不恢复时， 正常活动和谨慎的给药策略。然而，较差的指南遵守是一个普遍的问题， 担心，可能会阻碍吸收。 我们之前的研究使用了来自行为学的见解， 经济学和社会心理学，以提高指导方针的遵守。我们建议应用这些 应用经济学和社会心理学中的技术来改善阿片类药物 处方安全（AESOS）试验，以提高对CDC和俄勒冈州疼痛的依从性 疼痛管理指南。在R21阶段，我们将评估 实施以下候选推动：1）指导一致性行动， 当临床医生未能采取行动时发生），2）预先承诺（临床医生的预先承诺 指导他们将来的行为），3）理由 （临床医生输入的自由文本回答，解释为什么没有遵循指南， 在电子健康记录中记录为患者笔记）;当 默认值被删除，承诺不兑现，4）同行比较（一种类型的 社会动机的业绩报告）和5）推动提高突出性， 阿片类药物不良事件的可用性。在R33阶段，我们将进行AEOPS试验， 18-一个月的随机分组试验。该试验在美国的374个初级保健诊所进行。 比较三个条件：C1）同行比较和理由，C2）违约，预先承诺 或添加到C1干预措施中的可用不良事件，C3）教育对照。主 结果是临床医生每月累积的吗啡当量（ME）> 50 mg ME每日剂量。次要结局是苯二氮卓类药物联合处方和剂量率 递增至> 50 mg ME/天。我们预计AEOPS试验将提供新的知识， 关于如何提高对CDC慢性疼痛阿片类药物处方指南的依从性 以及一致的疼痛指南。这项试验也可能帮助我们了解如何防止未来 通过减少不必要的人口， 接触这些药物。

ABSTRACT There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm​. Last year, the Centers for Disease Control and Prevention (CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain” to encourage safe and effective alternatives to opioids, discontinuation of opioids when patients do not resume normal activities and prudent dosing strategies. However, poor guideline adherence is a general concern and may impede uptake. ​Our prior studies have used insights from behavioral economics and social psychology to increase guideline adherence. We propose to apply these techniques within the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial to improve adherence to the CDC and to the Oregon Pain Guidance pain management guideline. In the R21 phase, we will assess the feasibility of implementing the following candidate nudges: 1) Defaults (guideline concordant actions that take place when clinicians fail to act), 2) precommitments (advanced commitments by clinicians to guideline adherent behaviors that bind them to these behaviors in the future), 3) justifications (free-text responses entered by the clinician that explain why guidelines were not followed and which are recorded as a patient note in the electronic health record); these are triggered when defaults are removed and commitments are not honored, 4) peer comparisons (a type of socially motivated performance reporting) and 5) a nudge to increase the salience and availability of adverse opioid events. In the R33 phase, we will conduct the AESOPS trial, an 18-month cluster randomized trial. The trial is across 374 primary care clinics in the U.S. We compare three conditions: C1) Peer comparison and justification , C2) defaults, precommitments or available adverse events added to the C1 interventions, C3) education control. The primary outcomes is clinician aggregate monthly mg morphine equivalent (ME) for patients with ​>​50 mg ME daily dose. Secondary, outcomes are benzodiazepine co-prescribing and rate of dose escalation to ​>​50 mg ME/day. We anticipate that the AESOPS trial will provide new knowledge about how to improve adherence to the CDC Guideline for Prescribing Opioids for Chronic Pain and to concordant pain guidelines. The trial may also help us understand how to prevent future incidents of opioid use disorder and opioid poisoning death by lowering unnecessary population exposure to these drugs.