De‐implementing opioid prescribing in a dental group practice: Lessons learned

Abstract

Background Drug overdose has become a leading cause of accidental death in the United States. Between 2000 and 2015, the rate of deaths from drug overdoses increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (including opioid pain relievers and heroin). Unnecessary opioid prescribing is one of the factors driving this epidemic. Objectives The primary objective of this paper is to share lessons learned while conducting a randomized trial to de‐implement opioids for post‐extraction pain management utilizing clinical decision support (CDS) with and without patient education. The lessons learned from conducting this trial in a real‐world setting can be applied to future dissemination and implementation oral health research. Methods The sources informing lessons learned were generated from qualitative interviews conducted with 20 of the forty‐nine dental providers involved in the study following the implementation phase of the trial. Ongoing policy, social and environmental factors were tracked throughout the study. Results Dental providers in the trial identified the impact of training that involved health professionals sharing information about the personal impact of pain and opioid use. Additionally, they found utility in being presented with a dashboard detailing their prescribing patterns related to other dentists. For the 30 general dentists with access to the CDS, use of its portal varied widely, with most using it 10%–49% of the time related to extractions. Conclusions In the context of a downward trend in opioid prescribing and considering the influence of the COVID pandemic during the trial, dental providers indicated benefit in training about negative personal impacts of prescribing opioids, and personally relevant feedback about their prescribing patterns. Only modest use of the CDS was realized. Implementation of this trial was impacted by governmental and health system policies and the COVID pandemic, prompt the consideration of implications regarding continuing ways to limit opioid prescribing among dental providers.

Dissemination and implementation research for oral and craniofacial health: Background, a review of literature and future directions

“…To date, DIS has been formally applied to dental, oral and craniofacial health in a limited way, and mostly quite recently. Some ongoing work in the area is featured in this special issue (Rindal et al 107 ; Ross et al 108 ). Additionally, below, the relatively small body of literature in the area is summarized.…”

Perspectives on the future of dissemination and implementation research in oral and craniofacial sciences

“…This is a good example—from dentistry—of a de‐implementation study. (See the article by Rindal and colleagues in the special issue to which this article belongs 13 …”

Clinical Decision Support to Reduce Opioid Prescriptions for Dental Extractions using SMART on FHIR: Implementation Report

“…HealthPartners [21] was already paying close attention to opioids and undertaking several actions to reduce opioid prescribing by providers while the study was being implemented. In the context of a downward trend in opioid prescribing, dental providers identified several factors that led to reduced reliance on opioids, including governmental and health system opioid prescribing policy changes and the COVID-19 pandemic [22].…”