Study tests impact of email notifications on risky opioid prescribing

Study tests impact of email notifications on risky opioid prescribing

Researchers at Columbia University Mailman School of Public Health reported new findings from a clinical trial using email notifications from pharmacists to physicians and other practitioners to reduce risky opioid prescribing. The study, conducted in the military health system with government and academic researchers, found no proven impact of the warnings on prescribing. The results highlight the value of rigorous testing to ensure policies that make opioid prescribing safer as intended. The research was published online in the JAMA Health Forum.

The study focused on interactions between opioids and another class of drugs called benzodiazepines. Concomitant use of opioids and benzodiazepines is closely linked to overdose, but remains common: 3 million adults in the United States do it each year. In the study, researchers tested applied behavioral science and “nudge” techniques to promote safer prescribing of opioids and benzodiazepines.

While nudges have successfully promoted many types of high-quality health care, we lacked evidence on whether they could address common but risky interactions between opioids and benzodiazepines. Working with clinicians at Walter Reed, we conducted a gold standard randomized trial to address this evidence gap.”

Adam Sacarny, PhD, Columbia University Mailman School of Public Health, corresponding author of the study

Sacarny and associates conducted the trial in the Military Health System's National Capital Region, the area that includes Walter Reed National Military Medical Center. The study included 2,237 patients. 1,187 of these patients were randomly selected to receive email notifications from clinical pharmacists to their prescribers and primary care physicians. Researchers then tested whether the warnings reduced the likelihood that patients would receive opioids and benzodiazepines. They also examined whether the warnings led clinicians to limit risky prescriptions to their other patients.

The study found that patients whose doctors were notified by email later received similar amounts of opioids and benzodiazepines as patients whose doctors were never contacted. Doctors who were notified by email also prescribed similar amounts to those who were not. “Surprisingly, we found no statistically significant evidence that the emails made a difference for these patients or their doctors,” Sacarny said.

The study notes that this work was part of a quality improvement effort to make prescribing safer in the military health care system. However, unlike most quality improvement initiatives, the research team tested their work in a randomized trial. By including a control group that did not receive emails, researchers were able to show that improvements in prescribing over time would likely have occurred even without the warnings. The study suggests that this evidence-generating approach could be a model for other healthcare organizations seeking to continually improve patient care.

“Although we hoped the emails would work, our null results are still important and useful,” Sacarny said. "They show that the military's health resources can be better spent in other ways, and they save time for clinicians who might otherwise have to read and respond to the news," he added.

The evaluation team included members of the Office of Evaluation Sciences (OES), a group in the federal government that helps agencies answer priority questions using rigorous evaluation methods and administrative data. The authors of the study are Dr. Sacarny, who is also a member of OES; Elana Safran of OES; Dr. Mary Steffel of OES and Northeastern University; Jacob R. Dunham of Vista Defense Technologies; Dr. Orolo D. Abili, Lobat Mohajeri, Patricia T. Oh and Christopher Spevak of Walter Reed National Military Medical Center; Dr. Alan Sim of the Defense Health Agency; and Dr. Robert E. Brutcher of the Uniformed Services University of the Health Sciences. Dr. Spevak was the final author of the study. The study was supported by the Defense Health Agency through an interagency agreement with the U.S. General Services Administration, the government agency that hosts OES.

The study was supported by the Defense Health Agency through an interagency agreement with the US General Services Administration (DHA-2017-R-274).

Source:

Columbia University Mailman School of Public Health

Reference:

Sacarny, A., et al. (2022) Impact of pharmacist email notifications on concomitant prescribing of opioids and benzodiazepines by prescribers and primary care physicians. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2022.3378.

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