PDF(Pubmed)
Abstract：
UNASSIGNED: Excess opioid prescribing after surgery can result in prolonged use and diversion. Email feedback based on social norms may reduce the number of pills prescribed.
UNASSIGNED: To assess the effectiveness of 2 social norm-based interventions on reducing guideline-discordant opioid prescribing after surgery.
UNASSIGNED: This cluster randomized clinical trial conducted at a large health care delivery system in northern California between October 2021 and October 2022 included general, obstetric/gynecologic, and orthopedic surgeons with patients aged 18 years or older discharged to home with an oral opioid prescription.
UNASSIGNED: In 19 hospitals, 3 surgical specialties (general, orthopedic, and obstetric/gynecologic) were randomly assigned to a control group or 1 of 2 interventions. The guidelines intervention provided email feedback to surgeons on opioid prescribing relative to institutionally endorsed guidelines; the peer comparison intervention provided email feedback on opioid prescribing relative to that of peer surgeons. Emails were sent to surgeons with at least 2 guideline-discordant prescriptions in the previous month. The control group had no intervention.
UNASSIGNED: The probability that a discharged patient was prescribed a quantity of opioids above the guideline for the respective procedure during the 12 intervention months.
UNASSIGNED: There were 38 235 patients discharged from 640 surgeons during the 12-month intervention period. Control-group surgeons prescribed above guidelines 36.8% of the time during the intervention period compared with 27.5% and 25.4% among surgeons in the peer comparison and guidelines arms, respectively. In adjusted models, the peer comparison intervention reduced guideline-discordant prescribing by 5.8 percentage points (95% CI, -10.5 to -1.1; P = .03) and the guidelines intervention reduced it by 4.7 percentage points (95% CI, -9.4 to -0.1; P = .05). Effects were driven by surgeons who performed more surgeries and had more guideline-discordant prescribing at baseline. There was no significant difference between interventions.
UNASSIGNED: In this cluster randomized clinical trial, email feedback based on either guidelines or peer comparison reduced opioid prescribing after surgery. Guideline-based feedback was as effective as peer comparison-based feedback. These interventions are simple, low-cost, and scalable, and may reduce downstream opioid misuse.
UNASSIGNED: ClinicalTrials.gov NCT05070338.
UNASSIGNED: To assess the effectiveness of 2 social norm-based interventions on reducing guideline-discordant opioid prescribing after surgery.
UNASSIGNED: This cluster randomized clinical trial conducted at a large health care delivery system in northern California between October 2021 and October 2022 included general, obstetric/gynecologic, and orthopedic surgeons with patients aged 18 years or older discharged to home with an oral opioid prescription.
UNASSIGNED: In 19 hospitals, 3 surgical specialties (general, orthopedic, and obstetric/gynecologic) were randomly assigned to a control group or 1 of 2 interventions. The guidelines intervention provided email feedback to surgeons on opioid prescribing relative to institutionally endorsed guidelines; the peer comparison intervention provided email feedback on opioid prescribing relative to that of peer surgeons. Emails were sent to surgeons with at least 2 guideline-discordant prescriptions in the previous month. The control group had no intervention.
UNASSIGNED: The probability that a discharged patient was prescribed a quantity of opioids above the guideline for the respective procedure during the 12 intervention months.
UNASSIGNED: There were 38 235 patients discharged from 640 surgeons during the 12-month intervention period. Control-group surgeons prescribed above guidelines 36.8% of the time during the intervention period compared with 27.5% and 25.4% among surgeons in the peer comparison and guidelines arms, respectively. In adjusted models, the peer comparison intervention reduced guideline-discordant prescribing by 5.8 percentage points (95% CI, -10.5 to -1.1; P = .03) and the guidelines intervention reduced it by 4.7 percentage points (95% CI, -9.4 to -0.1; P = .05). Effects were driven by surgeons who performed more surgeries and had more guideline-discordant prescribing at baseline. There was no significant difference between interventions.
UNASSIGNED: In this cluster randomized clinical trial, email feedback based on either guidelines or peer comparison reduced opioid prescribing after surgery. Guideline-based feedback was as effective as peer comparison-based feedback. These interventions are simple, low-cost, and scalable, and may reduce downstream opioid misuse.
UNASSIGNED: ClinicalTrials.gov NCT05070338.
摘要：
■手术后过量的阿片类药物处方会导致长期使用和转移。基于社会规范的电子邮件反馈可能会减少处方药丸的数量。
■评估2种基于社会规范的干预措施对减少手术后指南不一致的阿片类药物处方的有效性。
■这项在2021年10月至2022年10月之间在加利福尼亚州北部的大型医疗保健提供系统中进行的集群随机临床试验包括一般，产科/妇科，18岁或18岁以上患者的骨科医生用口服阿片类药物处方出院回家。
■在19家医院，3个外科专业（一般，骨科,和产科/妇科）被随机分配到对照组或2个干预措施中的1个。指南干预向外科医生提供了阿片类药物处方相对于机构认可的指南的电子邮件反馈;同行比较干预提供了阿片类药物处方相对于同行外科医生的电子邮件反馈。在上个月，向外科医生发送了至少2种指南不一致的处方的电子邮件。对照组无干预。
■在12个月的干预期间，出院患者处方阿片类药物量高于相应程序指南的可能性。
■在12个月的干预期内，有38235名患者从640名外科医生中出院。在干预期间，对照组外科医生在上述指南中规定了36.8%的时间，而在同行比较和指南组中，外科医生中这一比例为27.5%和25.4%，分别。在调整后的模型中，同行比较干预将指南不一致的处方减少了5.8个百分点(95%CI,-10.5~-1.1;P=.03),而指南干预将不一致的处方减少了4.7个百分点(95%CI,-9.4~-0.1;P=.05).效果是由外科医生驱动的，他们进行了更多的手术，并且在基线时有更多的指南不一致的处方。干预措施之间没有显着差异。
■在这项整群随机临床试验中，基于指南或同行比较的电子邮件反馈减少了术后阿片类药物处方.基于指南的反馈与基于同行比较的反馈一样有效。这些干预措施很简单，低成本,和可扩展性，并可能减少下游阿片类药物滥用。
■ClinicalTrials.govNCT05070338。
■评估2种基于社会规范的干预措施对减少手术后指南不一致的阿片类药物处方的有效性。
■这项在2021年10月至2022年10月之间在加利福尼亚州北部的大型医疗保健提供系统中进行的集群随机临床试验包括一般，产科/妇科，18岁或18岁以上患者的骨科医生用口服阿片类药物处方出院回家。
■在19家医院，3个外科专业（一般，骨科,和产科/妇科）被随机分配到对照组或2个干预措施中的1个。指南干预向外科医生提供了阿片类药物处方相对于机构认可的指南的电子邮件反馈;同行比较干预提供了阿片类药物处方相对于同行外科医生的电子邮件反馈。在上个月，向外科医生发送了至少2种指南不一致的处方的电子邮件。对照组无干预。
■在12个月的干预期间，出院患者处方阿片类药物量高于相应程序指南的可能性。
■在12个月的干预期内，有38235名患者从640名外科医生中出院。在干预期间，对照组外科医生在上述指南中规定了36.8%的时间，而在同行比较和指南组中，外科医生中这一比例为27.5%和25.4%，分别。在调整后的模型中，同行比较干预将指南不一致的处方减少了5.8个百分点(95%CI,-10.5~-1.1;P=.03),而指南干预将不一致的处方减少了4.7个百分点(95%CI,-9.4~-0.1;P=.05).效果是由外科医生驱动的，他们进行了更多的手术，并且在基线时有更多的指南不一致的处方。干预措施之间没有显着差异。
■在这项整群随机临床试验中，基于指南或同行比较的电子邮件反馈减少了术后阿片类药物处方.基于指南的反馈与基于同行比较的反馈一样有效。这些干预措施很简单，低成本,和可扩展性，并可能减少下游阿片类药物滥用。
■ClinicalTrials.govNCT05070338。
