Feasibility and Acceptability of a Mobile Application to Monitor Opioid Use and Promote Behavior Modification Following Cesarean Section

Gutta, Sravanthi; Morgan, Jessica Kelley; Hart, Laura; Abdo, Annabelle; Leib, Alexa; Walther, Steven K.; Herrine, Gail

doi:10.4236/psych.2022.133024

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…Overall, participants rated ease of use and amount of time required as highly acceptable, with no logistical or technological issues being reported. This is congruent with our prior findings across several studies, including those involving young soldiers undergoing third molar extraction [ 24 , 25 ], adults undergoing tonsillectomy [ 26 ], and women undergoing cesarean section [ 27 , 28 ]. This study was the first to include a report by a patient of difficulty using the mobile app, which does warrant discussion.…”

Section: Discussionsupporting

confidence: 91%

“…We have used a public health research pipeline approach for designing, evaluating, and implementing behavioral health interventions, and the CPMRx mobile app has been shown to be feasible and acceptable for supporting postoperative pain management across several patient populations and surgery types, including young adults undergoing third molar extraction (dental clinic, Womack Army Medical Center) [ 24 , 25 ], adults undergoing tonsillectomy (ear, nose, and throat, WakeMed Hospital) [ 26 ], and women undergoing cesarean section (obstetrics and gynecology, Temple University Health) [ 27 , 28 ]. The effectiveness of the mobile app and clinical decision support tool has also been validated.…”

Section: Introductionmentioning

confidence: 99%

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A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study

Morgan,

Rawlins,

Walther

et al. 2023

JMIR Perioper Med

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Background Prescription opioid misuse risk is disproportionate among veterans; military veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse is costly in terms of morbidity, mortality, and humanitarian and economic burden and costs the Civilian Health and Medical Program of the Department of Veterans Affairs more than US $1.13 billion annually. Preventing opioid misuse at the time of prescription is a critical component in the response to the opioid crisis. The CPMRx mobile app has been shown to decrease the odds of opioid misuse during the postoperative period. Objective The overarching purpose of this feasibility pilot study was to explore whether deploying a mobile app (CPMRx) to track postoperative pain and medication use is feasible in a Department of Veterans Affairs medical center. In support of this goal, we had four complementary specific aims: (1) determine the technological and logistical feasibility of the mobile app, (2) assess the acceptability of the mobile app to participants, (3) measure demand for and engagement with the mobile app, and (4) explore the potential use of the mobile app to patients and providers. Methods Participants (N=10) were veterans undergoing total knee arthroplasty within the Veterans Health Administration provided with the CPMRx app to self-manage their pain during their 7-day at-home recovery following surgery. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile app for patients that includes a behavioral health intervention and a clinical decision support tool for health care providers that provides feedback about pain and medication use trends. Patients filled out paper questionnaires regarding acceptability at their postoperative follow-up appointment. Results Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the app was 4.9 of 5 (5=“very little”), and the average rating for ease of use was 4.4 of 5 (5=“very easy”). Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well with a mean number of mobile app entries of 34.1 (SD 20.1) during the postoperative period. There were no reported technological or logistical issues with the mobile app. Participants took an average of 25.13 (SD 14.37) opioid tablets to manage their postoperative pain. Conclusions Results of this study revealed that the use of a mobile app for pain and medication management during postoperative recovery was both feasible and acceptable in older veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential use of the mobile app to provide actionable insights to clinicians if adopted more widely.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study

Morgan,

Rawlins,

Walther

et al. 2023

JMIR Perioper Med

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View full text Add to dashboard Cite

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Evaluation of a mobile application to decrease opioid misuse in patients undergoing cesarean section: a randomized controlled trial

Abdo,

O’Connor,

Morgan

et al. 2024

BMC Pregnancy Childbirth

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Background Opioid misuse and addiction are at epidemic levels in the United States. Postoperative opioid prescription is inconsistent and often excessive, including for cesarean section patients. Technology, such as mobile applications and clinical decision support tools, can be used to decrease opioid use and misuse among patients, and to determine more appropriate prescribing practices for specific procedures. The objective of this study was to examine the preliminary impact of the Continuing Precision Medicine (CPM) mobile application to reduce the use of opioid pain medication among women who underwent cesarean section. The primary outcome is morphine milligram equivalents (MME), while the secondary outcomes will be delay to dosages, decrease of usage, and pain scores. Methods Patients undergoing cesarean section were randomized to either a control group or an experimental group, which used the CPMRx mobile app to help manage postoperative pain. Logistic regression analyses were run to predict opioid misuse by group (control [electronic monitoring blister pack only] versus CPMRx [electronic monitoring blister pack plus mobile application]) and odds ratios (ORs) were calculated. Relative risk (RR) was also estimated by log-binomial regression. Results In phase I, 105 patients were assessed for eligibility, however, 66 were excluded (not meeting criteria or declined to participate). In phase 2, 98 patients were assessed for eligibility, however, 48 were excluded for the aforementioned. Results of the logistic regression showed that opioid misuse differed significantly by group (χ 2 = 7.27, p = 0.007) with participants in the CPMRx group experiencing a 92% reduction in odds of opioid misuse compared to blister packs only (OR = 0.08, p = 0.03). Relative risk estimation by log-binomial regression also revealed that patients in the control group were at 7 times higher risk of opioid misuse than those using the CPMRx app (Wald χ 2 = 3.82, RR = 7.00, p = 0.05). Among the 21 participants in Phase I who did not misuse their prescription opioids, the average number of pills used was 2.7 (SD = 3.5); 95% of patients used 8 or fewer pills, 90% used 6 or fewer, 75% used 4 or fewer, and half of participants used 1 or fewer opioids. Conclusions Women using the CPMRx mobile application were less likely to misuse their prescription opioids during the postoperative period following cesarean section. A prescription of 7 tablets of 5 mg oxycodone may be a more appropriate prescription size among this group. Systematically right-sizing prescriptions, including for subgroups, may decrease both patient- and community-level risk of opioid misuse and reduce public health burden. Trial registration The study was registered at ClinicalTrials.gov (NCT05461196, 18/07/2022). ...

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Feasibility and Acceptability of a Mobile Application to Monitor Opioid Use and Promote Behavior Modification Following Cesarean Section

Cited by 2 publications

References 21 publications

A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study

A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study

Evaluation of a mobile application to decrease opioid misuse in patients undergoing cesarean section: a randomized controlled trial

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