Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial. Article

Full Text via DOI: 10.1007/s11606-024-08965-7 PMID: 39095571

Cited authors

  • Price-Haywood, Burton, Harden-Barrios, Bazzano, Shi, Lefante, Jamison

Abstract

  • BACKGROUND\nOBJECTIVE\nDESIGN\nPARTICIPANTS\nINTERVENTION\nMAIN MEASURES\nKEY RESULTS\nCONCLUSIONS\nTRIAL REGISTRATION\nHigh prevalence of depression or anxiety with opioid use for chronic pain complicates co-management and may influence prescribing behaviors.\nCompare clinical effectiveness of electronic medical record clinical decision support (EMR-CDS) versus additional behavioral health (BH) care management for reducing rates of high-dose opioid prescriptions.\nType 2 effectiveness-implementation hybrid stepped-wedge cluster randomized trial in 35 primary care clinics within a health system in LA, USA.\nPatients aged 18+ receiving chronic opioid therapy for non-cancer pain with depression or anxiety and matched controls.\nEMR-CDS included opioid risk mitigation procedures. BH care included cognitive behavioral therapy; depression or anxiety medication adjustments; and case management.\nOutcomes of interest included difference-in-difference (DID) estimate of changes in probability for prescribing high-dose morphine equivalent daily dose (MEDD ≥50 mg/day and MEDD ≥90), average MEDD, and rates of hospitalization, emergency department use, and opioid risk mitigation.\nMost participants were female with 3+ pain syndromes. Data analysis included 632 patients. Absolute risk differences for MEDD≥50 and ≥90 decreased post-index compared to pre-index (DID of absolute risk difference [95%CI]: -0.036 [-0.089, 0.016] and -0.029 [-0.060, 0.002], respectively). However, these differences were not statistically significant. The average MEDD decreased at a higher rate for the BH group compared to EMR-CDS only (DID rate ratio [95%CI]: 0.85 [0.77, 0.93]). There were no changes in hospitalization and emergency department utilization. The BH group had higher probabilities of new specialty referrals and prescriptions for naloxone and antidepressants.\nIncorporation of a multidisciplinary behavioral health care team into primary care did not decrease high-dose prescribing; however, it improved adherence to clinical guideline recommendations for managing chronic opioid therapy for non-cancer pain.\nClinicalTrials.gov ID NCT03889418.

Authors

Publication date

  • 2024

PubMed Central ID

  • PMC11576687

International Standard Serial Number (ISSN)

  • 0884-8734

Start page

  • 2952

End page

  • 2960

Volume

  • 39

Issue

  • 15