Empowering dentists to reduce opioid prescriptions to young people

授权牙医减少向年轻人开阿片类药物处方

基本信息

批准号：
10620388
负责人：
Douglas Oyler
金额：
$ 58.02万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10620388
关键词：
Academic Detailing Acetaminophen Acute Acute pain management Address Adolescent and Young Adult American Analgesics Architecture Behavior Bulla Clinic Clinical Trials Design Cluster randomized trial Community Trial Country Data Decision Making Dental Dental Care Dental Clinics Dental General Practice Dentistry Dentists Disease Dose Drug Monitoring Drug Prescriptions Education Educational Materials Effectiveness Electronic Health Record Enrollment Environmental Risk Factor Goals Ibuprofen Individual Intervention Interview Kentucky Knowledge Measures Modeling Morphine Motivation National Institute of Dental and Craniofacial Research Opioid Oral Surgeon Oral Surgical Procedures Outcome Overdose Pain Pain interference Pain management Patient Education Patients Persons Pharmaceutical Preparations Process Provider Public Health Recommendation Reporting Research Risk Safety Site Standardization Substance Use Disorder Surveys Testing Tooth Extraction Toothache United States Use Effectiveness Work academic intervention clinical decision support dental agent effective intervention effectiveness evaluation empowerment evidence based guidelines experience health record high risk high risk population implementation evaluation implementation intervention implementation outcomes implementation science improved innovation member milligram multi-component intervention multidisciplinary non-opioid analgesic novel novel strategies opioid exposure opioid misuse opioid use pill prescription opioid prescription opioid misuse primary endpoint provider factors recruit satisfaction secondary endpoint therapy design

项目摘要

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.

抽象的牙医是青少年和年轻人 (AYA) 的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改善疼痛控制或满意度无关。在 AYA 中，阿片类药物处方牙科手术后会增加阿片类药物滥用、使用障碍和过量的风险。长期目标是该项目旨在开发一个框架，以减少治疗急性牙痛的阿片类药物处方。该提案的目的是确定多方干预措施在减少 AYA 拔牙后牙科阿片类药物处方率。我们的中心假设是多组分需要进行干预才能显着减少 AYA 拔牙后阿片类药物处方。这该提案的基本原理是多成分干预将解决提供者的知识问题，动机和选择架构优于单一组件策略；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检验这个假设追求四个具体目标：在 UG3 期间，1）完成测试新方法所需的前期工作控制牙科治疗后以及 UH3 期间的急性疼痛：1) 确定一种新型药物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镇痛药，以减少 AYA 拔牙后的阿片类药物处方； 2）检查密钥旨在改变牙科专业决策行为的干预措施的实施结果； 3) 评估患者报告的拔牙后疼痛管理、镇痛使用和药物处置情况。到为了实现这些目标，我们提出了一项针对社区和学术诊所的阶梯式楔形集群随机试验在整个肯塔基州使用一对一提供者教育和提供者分配的创新干预措施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。这项研究将在肯塔基州至少 10 个最大的口腔外科诊所进行，招募至少 27 名供应商预计将为超过 40,000 名 AYA 进行拔牙手术。我们将使用以下方法评估有效性患者服用阿片类药物的二元指标的主要终点。次要终点包括干预的可接受性、适当性、可行性和保真度（UH3 目标 2）；以及患者报告的疼痛，疼痛干扰、止痛药的使用和药物处置（UH3 目标 3）。拟议的研究意义重大，因为它将为大规模实施干预措施以改变牙科决策提供一个框架采取基于证据的急性疼痛管理建议的行为，从而减少拔牙后阿片类药物的处方率。预期成果是建立一个框架，以有效实施减少 AYA 牙科阿片类药物处方的干预措施。结果将立即产生积极影响因为它们会限制不必要的阿片类药物暴露，而且从长远来看，因为它们将帮助牙科建立一个减少全美药物滥用障碍影响的框架。