Provider-Targeted Behavioral Interventions to Prevent Unsafe Opioid Prescribing for Acute Pain in Primary Care
Provider-Targeted Behavioral Interventions to Prevent Unsafe Opioid Prescribing for Acute Pain in Primary Care
The investigators will assess whether behavioral science-based interventions can "nudge"
 providers towards more evidence-based care for patients with acute non-cancer pain.

 Aim 1) Among opioid naïve primary care patients with acute non-cancer pain, compare the
 effect of the provider-targeted behavioral interventions (opioid justification and provider
 comparison), individually and in combination, on initial opioid prescription, initial use of
 non-opioid management, and patient-reported pain and function.

 Aim 2) Compare the effect of the 2 provider-targeted behavioral interventions, individually
 and in combination, on unsafe opioid prescribing and transition to chronic opioid therapy.

 Aim 3) Assess provider satisfaction and experience with the provider-targeted behavioral
 interventions.

 Hypotheses:

 Aim 1, H1a: Compared with the guideline (usual care) alone, the addition of the opioid
 justification and provider comparison behavioral interventions will be associated with a
 decreased proportion of opioid prescription and increased proportion of non-opioid management
 at the initial outpatient visit for acute non-cancer pain.

 Aim 1, H1b: Compared with usual care (guideline) alone, the addition of the opioid
 justification and provider comparison behavioral interventions will be associated with no
 difference in patient-reported pain, function, and satisfaction at 1, 6, and 12 months.

 Aim 2, H2: Compared with the usual care (guideline), the addition of opioid justification and
 provider comparison behavioral interventions will be associated with a decreased proportion
 of patients receiving unsafe opioid therapy and a decreased proportion of patients
 transitioning to chronic opioid therapy.

 Study Design: Pragmatic, cluster-randomized clinical trial in 48 primary care clinics.

 Study Population: The patient population will be 19,855 opioid naïve adults who present to
 clinic with acute uncomplicated musculoskeletal pain or headache.

 Primary and Secondary Outcomes: The primary outcome measures will be receipt of an initial
 opioid prescription and unsafe opioid prescribing. Secondary outcomes will be non-opioid pain
 management, and, in 514 patients, patient-reported pain and function.

 Analytic Plan: The investigators will test for differences in the primary and secondary
 outcomes among the 4 intervention groups.

 Once completed, the project will provide evidence that health systems and other stakeholders
 need to implement interventions to prevent unsafe opioid prescribing.
1. Patient Participants

 Inclusion Criteria:

 -  Age 18 years or older; ii) index outpatient encounter with International
 Classification of Disease (ICD)-10 code for acute neck, back, or other
 musculoskeletal and headache diagnosis ("acute" defined as no similar diagnosis
 in past 3 months).

 Exclusion Criteria:

 -  Cancer diagnosis (other than non-melanoma skin cancer)

 -  Receipt of opioid prescription within 12 months of index outpatient encounter

 2. Providers

 Inclusion Criteria:

 -  Primary care provider (MD, Doctor of Osteopathy (DO), Physician Assistant (PA), Nurse
 Practitioner (NP)) at participating practice

 Exclusion Criteria:

 -  None