Empowering dentists to reduce opioid prescriptions to young people

摘要 牙医是青少年和年轻人(AYA)阿片类药物的主要处方者，尽管阿片类药物的使用 拔牙后与疼痛控制或满意度的改善无关。在AYAS，一种阿片类药物处方 牙科手术后增加阿片类药物滥用、使用障碍和过量使用的风险。的长期目标是 该项目旨在开发一个框架，以减少阿片类药物处方为AYA治疗急性牙痛。 这项建议的目标是建立多成分干预的有效性，以减少 AYAS患者拔牙后的牙科阿片类处方率。我们的中心假设是，一个多组分 需要进行干预，以大幅减少AYA的阿片类药物处方。这个 这一提议的基本原理是，多成分干预将解决提供商的知识， 激励，并选择比单一组件策略更好的架构；将吸引和教育患者； 并将提供实物供分发，而不是阿片类药物处方。我们将通过以下方式验证这一假设 追求四个具体目标：在普遍定期审议期间，1)完成必要的前期工作，以测试新方法 为了管理牙科治疗后的急性疼痛，以及在UH3期间：1)建立一种新的有效性 使用学术细节、患者教育和泡罩包装的教育和配药方法 非阿片类止痛药减少AYA拔牙后阿片类药物处方；2)检查关键 旨在改变牙科专业决策行为的干预措施的实施结果； 以及3)评估患者报告的拔牙后疼痛管理、止痛药的使用和药物处理。至 为了实现这些目标，我们提出了社区和学术诊所的阶梯楔形整群随机试验 在整个肯塔基州，使用一对一提供商教育和提供商分销的创新干预 患者教育材料和含有对乙酰氨基酚和布洛芬的标准化泡罩包装。本研究 将在肯塔基州至少10家最大的口腔外科诊所进行，至少有27家注册 预计将为40,000多名AYA提供拔牙服务。我们将使用 患者级阿片类药物处方的二进制指标的主要终点。次要端点 包括干预可接受性、适当性、可行性和保真度(UH3目标2)；以及患者报告的疼痛， 疼痛干预、止痛药使用和药物处置(UH3目标3)。这项拟议的研究具有重要意义，因为 它将为广泛实施干预措施提供一个框架，以修改牙科决策 对急性疼痛管理的循证建议的行为，导致减少 拔牙后阿片类处方率。预期成果是一个框架，以执行有效 减少AYA牙科阿片类药物处方的干预措施。结果将立即产生积极的影响 因为它们将限制不必要的阿片类药物暴露，长期如此，因为它们将帮助牙科医生建立 减少全美药物使用障碍影响的框架。

ABSTRACT Dentists are the leading prescriber of opioids to adolescents and young adults (AYAs), even though opioid use after tooth extraction is not associated with improved pain control or satisfaction. In AYAs, an opioid prescription after a dental procedure increases the risk of opioid misuse, use disorder, and overdose. The long-term goal of this project is to develop a framework to reduce opioid prescriptions to AYAs for treatment of acute dental pain. The objective of this proposal is to establish the effectiveness of a multicomponent intervention at reducing dental opioid prescription rates after tooth extraction in AYAs. Our central hypothesis is that a multicomponent intervention is required to produce significant reductions in post-extraction opioid prescriptions to AYAs. The rationale underlying this proposal is that a multicomponent intervention will address provider knowledge, motivation, and choice architecture better than a single-component strategy; will engage and educate patients; and will provide a physical item for distribution instead of an opioid prescription. We will test this hypothesis by pursuing four specific aims: in the UG3 period, 1) complete requisite preliminary work to test a new approach to manage acute pain following dental treatment, and in the UH3 period: 1) establish effectiveness of a novel educational and drug-dispensing approach using academic detailing, patient education, and blister-packaged non-opioid analgesics to reduce opioid prescriptions following tooth extraction among AYAs; 2) examine key implementation outcomes of the intervention designed to modify dental professional decision-making behaviors; and 3) assess patient-reported pain management, analgesic use, and drug disposal after tooth extraction. To accomplish these aims, we propose a stepped wedge cluster randomized trial of community and academic clinics across Kentucky using an innovative intervention of one-on-one provider education plus provider distribution of patient education materials and standardized blister packs containing acetaminophen and ibuprofen. This study will be conducted across at least 10 of the largest oral surgery practices in Kentucky, enrolling at least 27 providers expected to perform tooth extractions on over 40,000 AYAs. We will assess effectiveness using a primary endpoint of the patient-level binary indicator of being prescribed an opioid. Secondary endpoints include intervention acceptability, appropriateness, feasibility, and fidelity (UH3 aim 2); and patient-reported pain, pain interference, analgesic use, and drug disposal (UH3 aim 3). The proposed research is significant because it will provide a framework for wide-scale implementation of interventions to modify dental decision-making behaviors towards evidence-based recommendations for acute pain management, resulting in a reduction in opioid prescription rates after tooth extraction. The expected outcome is a framework to implement effective interventions to reduce dental opioid prescribing to AYAs. The results will have a positive impact immediately because they will limit unnecessary opioid exposure, and long-term because they will help dentistry build a framework for reducing the impact of substance use disorders across the United States.