Improving Patient Knowledge and Safe Use of Opioids: A Randomized Controlled Trial

Abstract

Objectives: The use of opioid analgesics in the United States has significantly increased in recent years. However, there is minimal consensus on what discharge counseling should accompany these high-risk prescriptions and large variations in what is done in practice. The objective of this study was to evaluate the effect of a dual-modality (written and spoken) literacy-appropriate educational strategy on patients' knowledge of and safe use of opioid analgesics.Methods: This was a prospective, randomized controlled trial. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new prescriptions for hydrocodone-acetaminophen were enrolled. Patients were randomized to receive either usual care or the educational intervention. The educational intervention was a one-page information sheet about hydrocodone-acetaminophen, which was both given to the patients and read aloud by the research assistant (nonblinded). Follow-up phone calls were conducted 4 to 7 days after the visit to assess patient knowledge about the medication and self-report of activities associated with safety of use (e.g., double-dipping with acetaminophen, storage, use with alcohol or while driving).Results: A total of 274 patients were enrolled; 210 completed follow-up (110 usual care and 100 intervention). No significant differences in baseline characteristics emerged between the study arms; 42% were male, and 51% were white, with a median age of 43 years. Half of patients had non-back pain orthopedic injuries (49.5%). On follow-up, overall knowledge was poor, with only 28% able to name both active ingredients in the medication. The intervention group had better knowledge of precautions related to taking additional acetaminophen (usual care 18.2%, 95% confidence interval [CI] = 10.9% to 25.5% vs. intervention 38%, 95% CI = 28.3% to 47.7%; difference = 27.6, 95% CI of difference = 21.5 to 33.7) and knowledge of side effects (usual care median = 1, interquartile range [IQR] 0 to 2 vs. intervention median = 2, IQR = 1 to 2; p < 0.0001). Additionally, those who received the intervention were less likely to have reported driving within 6 hours after taking hydrocodone (usual care 13.6%, 95% CI = 7.2% to 20% vs. intervention 3%, 95% CI = -0.3% to 6.3%; difference = 10.6, 95% CI of difference = 3.4 to 17.9). There was no difference between groups related to knowledge about drinking alcohol while taking hydrocodone (overall 18.1%) or knowledge that the opioid could be addictive (overall 72.4%).Conclusions: This simple strategy improved several, but not all, aspects of patient knowledge and resulted in fewer patients in the intervention arm driving while taking hydrocodone. Integration of a patient education document into conversations about opioids holds promise for improving patient knowledge about these high-risk medications.ACADEMIC EMERGENCY MEDICINE 2015;22:331-339

Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

“…In addition, both studies involved interventions requiring significant cost and resources that may not be available to all care providers. 17,18 The dramatic increase in proper opioid disposal in our study and the reduction in risky behaviours documented previously with patient-directed education, including driving under the influence of opioids and borrowing and lending opioids, may highlight the lack of information on opioid management that prescribers provide patients in standard care. 17,18 These studies also indicate that patients are inclined to manage opioids properly and return unused portions to the pharmacy if they are given the appropriate information.…”

“…17,18 The dramatic increase in proper opioid disposal in our study and the reduction in risky behaviours documented previously with patient-directed education, including driving under the influence of opioids and borrowing and lending opioids, may highlight the lack of information on opioid management that prescribers provide patients in standard care. 17,18 These studies also indicate that patients are inclined to manage opioids properly and return unused portions to the pharmacy if they are given the appropriate information. Our low-cost education technique had a significant impact on self-reported proper opioid disposal and can be easily reproduced at other centres and integrated into information provided to postoperative patients.…”

“…10 A 10% increase was selected as this is a similar absolute improvement in opioid behaviours noted in other educational intervention studies. 17,18 We anticipated a 60% survey response rate based on other surveys performed at our institution.…”

“…Comparable studies are lacking in surgical patients, yet two recent studies in non-surgical patients assessed the role of opioid education on patient knowledge. 17,18 In one study, 274 patients discharged from the emergency department with an opioid prescription were randomly assigned to combined verbal and written opioid education or standard care. The educational intervention in these patients improved opioid knowledge and reduced the rate of driving while taking opioids.…”

“…At one month follow-up, opioid knowledge improved and aberrant opioid behaviours were reduced. 17 Neither of these studies addressed appropriate opioid disposal, a vital step in limiting opioid diversion. In addition, both studies involved interventions requiring significant cost and resources that may not be available to all care providers.…”