Opioid medications make a significant contribution to the global 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.
The trial will test the ability of novel Clinical Decision Support (CDS) tool to support optimal, non-opioid pain management following dental extraction. US-based 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 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 clinical decision support 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.
Professor Heiko Spallek says "this study is highly significant because it could provide data to guide dentists and policymakers on innovative and effective approaches to reduce the millions of opioid prescriptions written by dentists each year in the US as well as in Australia. While this project is funded by the National Institutes of Health and will take place in the US, the study's novel use of clinical decision support to include both provider- and the patient-focused strategies can be applied in Australia as well."
Professor Spallek will contribute his expertise in health information technology and system workflow mapping to inform the development of the CDS for this project that is funded with USD 2,9 million. He is currently Principal Investigator with Dr Brad Rindal on another NIH grant that deploys a CDS to improve dental providers' delivery of brief tobacco interventions when treating patients who smoke. Having gained a deep understanding of Health Information Technology after working more than two decades in the area of dental informatics, Professor Spallek will provide advice on how to build the CDS for the potential future dissemination to other health care systems, including ones in Australia.
Title: De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions
Principal investigator: Brad Rindal, DDS
Funding source: National Institute of Dental and Craniofacial Research (U01DE027441)
Award period: September 1, 2017 - August 31, 2021
Award amount: $2,901,907
HP Project Team: Steve Asche, MA, Bill Rush, PhD, Jeanette Ziegenfuss, PhD
Collaborators: Friends Research Institute, Shannon Gwin Mitchell, PhD (co-PI), Jan Gryczynski, PhD, Robert Schwartz, MD, Heiko Spallek, DMD, PhD, MSBA(CIS)
Contacts for additional information: