The primary objective of this project is to de-implement the use of opioid analgesics for the management of postoperative pain following dental extractions and to implement effective alternative pain management. We propose a cluster-randomized trial designin which dental practitioners will be randomly assigned to 1 of 3 conditions involving different implementation strategies. The first condition, Standard Practice, will serve as a control condition. The second condition will implement a clinical decision support (CDS) tool that will extract patient history and interface with the state prescription drug monitoring program to provide personalized recommendations for analgesic prescribing and offer language for discussing optimal, evidence-based non- opioid pain management with dental extraction patients. The third condition will involve an enhanced version of the CDS (CDS-E) that will also include information regarding optimal, evidence-based, non-opioid pain management delivered directly to the patient both before and following the dental extraction visit. We will examine opioid and non-opioid prescribing data from the electronic health record across study arms as well as other provider- and patient-focused outcomes using mixed methods.
Opioid medications make a significant contribution to our nation's epidemic of fatal and non-fatal overdoses. Inappropriate prescribing (ie, prescribing opioids when not clinically necessary, or in higher doses or for longer than needed) is a key factor driving the opioid epidemic and requires fundamental changes at the practice level. Millions of dental extractions are performed each year on a wide range of patients. The overarching goal of this project is to de-implement the reliance of opioid analgesics and to implement reliance on non-opioid analgesics to manage postoperative pain following dental extractions. We will compare different strategies to reduce the reliance on opioids and increase the use of alternative pan management approaches utilizing information support tools aimed at both providers and their dental extraction patients.
