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| Name | Class |
|---|---|
| United States Department of Defense | FED |
| General Services Administration (GSA) | FED |
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The purpose of this effort is to use informative e-mails to improve the process of prescribing of opioids and benzodiazepines within the National Capital Region/Military Health System (NCR/MHS), with the aim of decreasing concurrent opioid and benzodiazepine prescribing.
The purpose of this effort is to use low-cost informative e-mails to improve the process of prescribing of opioids and benzodiazepines within the National Capital Region/Military Health System (NCR/MHS), with the aim of decreasing concurrent opioid and benzodiazepine prescribing. Both the VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain (2017) and the CDC Guideline for Prescribing Opioids for Chronic Pain (2016) strongly recommend against the concurrent use of opioids and benzodiazepines. Taken together, these drugs could cause respiratory depression, enhanced sedation, and death. The intervention population will be prescribers and primary care managers associated with patients who have recently received concurrent prescriptions of opioids and benzodiazepines. Using a randomized approach, we will allocate the NCR/MHS providers associated with patients with concurrent prescriptions for opioids and benzodiazepines to one of two conditions:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| E-Mail Alert | Active Comparator | Send email to the patient's opioid prescriber(s), benzodiazepine prescriber(s), and/or primary care manager. |
|
| As-Usual | No Intervention | As-usual (no email) approach. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| E-mail Alert | Behavioral | Encrypted email to the following providers: the patient's opioid prescriber(s), benzodiazepine prescriber(s), and/or primary care manager. If there is more than one provider, they are copied together on the same message. The email identifies the concurrent prescriptions, details the patient's prescription history, includes relevant VA/DoD guidelines, states the risk of concurrent prescribing to patient, and provides action steps and relevant resources. When multiple providers are involved, the message encourages the providers to coordinate with each other and provides provider contact information to facilitate this communication. |
| Measure | Description | Time Frame |
|---|---|---|
| Overlapping Days | Overlapping days of opioids and benzodiazepines, determined using the dates of service and days supply of the prescription drug fills | 90 days |
| Opioid Days | Days of opioids received | 90 days |
| Benzodiazepine Days | Days of benzodiazepines received | 90 days |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Robert E Brutcher, PharmD,PhD | Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences | Principal Investigator |
| Alan Sim, PhD | Defense Health Agency | Principal Investigator |
| Elana Safran, MPP | General Services Administration (GSA) | Principal Investigator |
| Adam Sacarny, PhD | General Services Administration and Columbia University | Principal Investigator |
| Mary Steffel, PhD | General Services Administration and Northeastern University | Principal Investigator |
| Christopher J Spevak, MD, MPH, JD | Walter Reed National Medical Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Walter Reed National Military Medical Center | Bethesda | Maryland | 20889 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36218952 | Derived | Sacarny A, Safran E, Steffel M, Dunham JR, Abili OD, Mohajeri L, Oh PT, Sim A, Brutcher RE, Spevak C. Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers: A Randomized Clinical Trial. JAMA Health Forum. 2022 Sep 2;3(9):e223378. doi: 10.1001/jamahealthforum.2022.3378. |
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