Effects of continued use of information interventions on opioid prescribing

Last registered on October 27, 2021

Pre-Trial

Trial Information

General Information

Title
Effects of continued use of information interventions on opioid prescribing
RCT ID
AEARCTR-0008439
Initial registration date
October 26, 2021
Last updated
October 27, 2021, 10:25 PM EDT

Locations

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Primary Investigator

Affiliation
The Social insurance Institution of Finland

Other Primary Investigator(s)

PI Affiliation
The Social Insurance Institution of Finland
PI Affiliation
Jyväskylä University School of Business and Economics
PI Affiliation
Jyväskylä University School of Business and Economics

Additional Trial Information

Status
In development
Start date
2019-05-29
End date
2022-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We study the effects of an information intervention on opioid prescribing and patients’ health outcomes. The intervention was a personal letter sent to physicians who had prescribed strong opioid painkillers (oxycontin or fentanyl) to a patient who had purchased these medicines for at least three months. These physicians were identified and randomized into treatment and control group. The letter was sent to physicians in the treatment group (n=3,689) on May 27 2019 and to physicians in the control group (n=3,679) on December 10 2019. The intervention letter contained personalized prescribing feedback and information about pain treatment with opioids. We also analyze the effects of the intervention separately for those physicians who received an information intervention in 2017 and/or 2018 as well. The study will inform policy makers on the usefulness of information letters as a long-term policy tool in reducing opioid prescribing and other potentially harmful clinical practices.
External Link(s)

Registration Citation

Citation
Pehkonen, Jaakko et al. 2021. "Effects of continued use of information interventions on opioid prescribing." AEA RCT Registry. October 27. https://doi.org/10.1257/rct.8439-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
From the group of physicians, who had prescribed oxycontin or fentanyl to a patient who had purchased at least three months’ supply of these substances in 2018, 3,689 randomly selected were sent a letter containing information about pain treatment with opioids and prescribing recommendations. The same letter was sent to 3 679 physicians in the control group six months later.
Intervention Start Date
2019-05-29
Intervention End Date
2019-12-10

Primary Outcomes

Primary Outcomes (end points)
1. Number of prescribed fentanyl (ATC: N01AH01) and oxycodone (ATC: N02AA05) Morphine Milligram Equivalences (MME)
2. Number of fentanyl and oxycodone prescriptions
Primary Outcomes (explanation)
We use a natural logarithmic transformation of variables measured in MMEs

Secondary Outcomes

Secondary Outcomes (end points)
1. Number of prescribed opioid (ATC: N02A, N01AH, N07BC) MMEs
2. Number of opioid prescriptions

Substitution to other drugs:
1. Prescribed Defined Daily Doses (DDDs) of other pain medicines (ATC: M01, N02BE01)
2. Number of other pain medicine prescriptions

Patient-level outcomes:
1. Number of delivered fentanyl and oxycodone MMEs
2. Number of delivered opioid MMEs
3. Delivered DDDs of other pain medicines

If we gain access to patient-level discharge data, we will also study the effects of the intervention on the following health outcomes:

1. Number of health care contacts
2. Number of opioid related health care contacts (ICD-10: F11, T36, and T40 and corresponding ICPC-2 codes).
3. Number of inpatient contacts
4. Number of opioid related inpatient contacts.
5. Number of days Hospitalized
Secondary Outcomes (explanation)
We use a natural logarithmic transformation of variables measured in MMEs and DDDs.

Experimental Design

Experimental Design
All physicians (N=7368) were identified who had prescribed strong opioids (oxycodone or fentanyl) to a patient (patients who were entitled to special reimbursement from national health insurance based on cancer diagnosis were excluded) who had purchased more than 3 months’ supply of strong opioids in 2018 in Finland. 3 689 of these physicians (treatment group) were randomly selected to receive a letter containing information on opioid use in pain treatment. The letters were sent in May 2019. The same letter was sent to other 3 679 of the identified physicians (control group) on December 10 2019.
We use nationwide register data on prescribing, health care utilization and diagnoses to analyze the effects of the intervention. We compare opioid prescribing and health outcomes in the treatment and control groups. For health outcomes, we compare the patients who have received a prescription from a physician in the treatment group to patients of the physicians in the control group. Furthermore, when studying effects on health, we exclude patients who have received a fentanyl or oxycodone prescription from physicians in both groups.
Experimental Design Details
Not available
Randomization Method
Randomization was done by the Social Insurance Institution of Finland in office by a computer.
Randomization Unit
Physician
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
3,689 physicians in the treatment group and 3,679 physicians in the control group.
Sample size: planned number of observations
3,689 physicians in the treatment group and 3,679 physicians in the control group.
Sample size (or number of clusters) by treatment arms
3,689 physicians in the treatment group and 3,679 physicians in the control group.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

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