Evaluation of a Structured Hospital-Community Care Follow-up Based on Perceived Quality of Care After Surgery, Aimed at Reducing Persistent Opioid Use in Primary Care: a Pragmatic Randomized Controlled Trial

Evaluation of a Structured Hospital-Community Care Follow-up Based on Perceived Quality of Care After Surgery, Aimed at Reducing Persistent Opioid Use in Primary Care: a Pragmatic Randomized Controlled Trial

The OPTIMISTE program is based on a structured postoperative follow-up centered on patients' subjective perception of recovery using validated Patient Reported Outcome Measures (PROMs), including the mQoR-15f score. Follow-up is delivered by specifically trained nurses and embedded in a decompartmentalized care model combining in-person and remote interactions, integrating hospital teams and primary care professionals within a coordinated pathway.

OPTIMISTE was recently evaluated in a multicenter randomized controlled trial, the SUPPORT study (NCT06182254), which included 280 patients. The study demonstrated a significant impact of PROM-based follow-up on perceived recovery at postoperative day 35, and more importantly, an approximately 50% reduction in the proportion of patients with persistent opioid use at that time point. Although this was a secondary endpoint, the findings suggest that active postoperative monitoring centered on patient-reported outcomes and rapidly relayed to community care providers represents a major lever for preventing opioid misuse after surgery.

However, these results require further confirmation and refinement. First, the effect on persistent opioid consumption needs to be validated as a primary endpoint. Second, despite the benefit observed, more than 12% of patients in the intervention group still exhibited persistent opioid use five weeks after surgery, compared with 21% in the control group. This residual persistence, although reduced, remains clinically concerning and indicates that the current OPTIMISTE model does not yet fully prevent unanticipated prolonged opioid exposure.

The hypothesis of the present protocol is that the effectiveness of OPTIMISTE in reducing postoperative persistent opioid use can be strengthened through earlier, more individualized and primary-care-driven management. This enhancement relies on better mobilization of community healthcare professionals - general practitioners, community nurses and pharmacists - supported by digital health tools and reinforced coordination channels such as secure platforms, teleconsultations and structured transmission of PROM scores.

By systematically integrating primary care providers into longitudinal postoperative follow-up guided by PROMs, the protocol aims to improve therapeutic responsiveness, reduce unjustified prolonged prescriptions and promote early tapering when clinically appropriate. The objective is to optimize hospital-community coordination in order to amplify the impact of the OPTIMISTE pathway on patient-perceived recovery and opioid stewardship.

Ultimately, this research seeks to demonstrate that strengthening the role of primary care, combined with fine-grained assessment of patient-reported recovery, represents an effective, ethical and scalable strategy to improve the quality, safety and efficiency of postoperative care pathways while sustainably reducing persistent opioid use at both individual and population levels.

The study is an open-label, multicenter, randomized controlled trial comparing two groups:

1. Control group Participants in the control group receive the usual conventional postoperative follow-up, notably by the surgeon and the attending physician.
2. Experimental group

In addition to the usual conventional follow-up, participants in the experimental group benefit from a comprehensive, closely coordinated care pathway between hospital and primary care, based on active collaboration with community healthcare professionals. This enhanced follow-up includes:

• Establishment of a personalized recovery trajectory,
• Early identification of any delay or difficulty in the recovery process,
• Adaptation of follow-up and adjustment of the care pathway in response to potential complications,
• Generation of a personalized report transmitted to the general practitioner to facilitate ongoing care,
• Simplified access to specialist consultations if clinically required, and
• a pharmaceutical consultation with the community pharmacist to optimize and secure medication use.

The program also integrates specially trained nurses who assess patients' health status according to their own perception (OPTIMISTE follow-up). From postoperative day 14 onward, if a risk of persistent opioid use is identified, a coordinated intervention between hospital and community care is initiated to ensure timely therapeutic adjustments, promote appropriate tapering, and prevent unjustified prolonged opioid exposure.

Inclusion Criteria:

• Male or female
• Adult patient, with no upper age limit
• Undergoing scheduled or unscheduled surgery in a center participating in the research
• Subject affiliated to a social health insurance scheme
• Subject able to understand the objectives and risks related to the research and to give informed consent, dated and signed

Exclusion Criteria:

• Inability to administer the mQoR-15f questionnaire (cognitive disorders, language barrier)
• Patient who has already received previous follow-up by the OPTIMISTE team
• Patient enrolled in a therapeutic trial that may affect post-operative recovery quality.
• Pregnant or breastfeeding woman
• Inability to provide the subject with informed information (subject in an emergency situation, difficulties in understanding, etc.)
• Subject under legal protection, guardianship or curatorship