TY - JOUR
T1 - Shared Decision-Making Tool for Opioid Prescribing After Ambulatory Orthopedic Surgery in Veterans
T2 - A Randomized Controlled Clinical Trial
AU - Bolson, Rajshri
AU - Lalka, Andy
AU - Korrell, Hannah
AU - Sibbel, Sarah E.
AU - Bartels, Karsten
N1 - Funding Information:
This material is the result of work supported with resources and the use of facilities at the Rocky Mountain Regional Veterans Affairs Medical Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Veterans Administration or the United States Government. This project was supported by National Institutes of Health ( NIH )/ National Center for Advancing Translational Sciences Colorado Clinical & Translational Science Award grant number UL1 TR002535, NIH National Institute on Drug Abuse grant number K23DA040923, and Agency for Healthcare Research and Quality grant number R01HS027795. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH or Agency for Healthcare Research and Quality views.
Funding Information:
This material is the result of work supported with resources and the use of facilities at the Rocky Mountain Regional Veterans Affairs Medical Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Veterans Administration or the United States Government. This project was supported by National Institutes of Health (NIH)/National Center for Advancing Translational Sciences Colorado Clinical & Translational Science Award grant number UL1 TR002535, NIH National Institute on Drug Abuse grant number K23DA040923, and Agency for Healthcare Research and Quality grant number R01HS027795. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH or Agency for Healthcare Research and Quality views.
Publisher Copyright:
© 2022 The Authors
PY - 2022/7
Y1 - 2022/7
N2 - Purpose: We examined whether an educational, shared-decision-making tool designed to empower patients, individualize pain management, and maximize use of nonopioid, over-the-counter analgesics reduces opioid use and waste while maintaining adequate pain relief. Methods: We developed an educational, shared-decision-making tool regarding postoperative pain medication for outpatient hand surgery. Patients randomized to groups with and without the tool were surveyed for 4 weeks after surgery. Survey variables included Patient-Reported Outcomes Measurement Information System pain intensity and pain interference scores, as well as the number of oxycodone or over-the-counter pills taken. Results were compared using chi-squared, Wilcoxon rank-sum, and Welch's t tests. Results: Fifty-three patients participated: 25 in the shared-tool group and 28 in the no-tool group. The mean age was 60 years, with more women in the no-tool group than the shared-tool group (n =17 versus 11, respectively). The shared-tool group averaged 6.4 prescribed oxycodone pills, versus 10 for the no-tool group (P < .01). The median numbers of oxycodone pills taken the first week after surgery were 2 (interquartile range, 6) for the shared-tool group and 3 (interquartile range, 6) for the no-tool group (P = .97). Patient-reported outcome measures for pain intensity and pain interference were not significantly different for weeks 1, 3, and 4 after surgery. Pain interference was significantly lower in week 2 in the shared-tool group (difference, −4.4; 95% confidence interval, −8.57 to −0.30; P = .04). Conclusions: The shared-tool group had equivalent or better pain control and were prescribed a lower number of opioid pain pills than the no-tool group. Both groups used nonopioid medications, with no difference in the types of over-the-counter medications used. Shared decision-making strategies could be applied to other outpatient orthopedic surgical settings, and may reduce the amount of opioids prescribed without compromising pain control. Type of study/level of evidence: Therapeutic II.
AB - Purpose: We examined whether an educational, shared-decision-making tool designed to empower patients, individualize pain management, and maximize use of nonopioid, over-the-counter analgesics reduces opioid use and waste while maintaining adequate pain relief. Methods: We developed an educational, shared-decision-making tool regarding postoperative pain medication for outpatient hand surgery. Patients randomized to groups with and without the tool were surveyed for 4 weeks after surgery. Survey variables included Patient-Reported Outcomes Measurement Information System pain intensity and pain interference scores, as well as the number of oxycodone or over-the-counter pills taken. Results were compared using chi-squared, Wilcoxon rank-sum, and Welch's t tests. Results: Fifty-three patients participated: 25 in the shared-tool group and 28 in the no-tool group. The mean age was 60 years, with more women in the no-tool group than the shared-tool group (n =17 versus 11, respectively). The shared-tool group averaged 6.4 prescribed oxycodone pills, versus 10 for the no-tool group (P < .01). The median numbers of oxycodone pills taken the first week after surgery were 2 (interquartile range, 6) for the shared-tool group and 3 (interquartile range, 6) for the no-tool group (P = .97). Patient-reported outcome measures for pain intensity and pain interference were not significantly different for weeks 1, 3, and 4 after surgery. Pain interference was significantly lower in week 2 in the shared-tool group (difference, −4.4; 95% confidence interval, −8.57 to −0.30; P = .04). Conclusions: The shared-tool group had equivalent or better pain control and were prescribed a lower number of opioid pain pills than the no-tool group. Both groups used nonopioid medications, with no difference in the types of over-the-counter medications used. Shared decision-making strategies could be applied to other outpatient orthopedic surgical settings, and may reduce the amount of opioids prescribed without compromising pain control. Type of study/level of evidence: Therapeutic II.
KW - Hand surgery
KW - Opioids
KW - Pain management
KW - Shared decision-making
KW - Veterans
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U2 - 10.1016/j.jhsg.2022.05.003
DO - 10.1016/j.jhsg.2022.05.003
M3 - Article
C2 - 35880150
AN - SCOPUS:85132796121
SN - 2589-5141
VL - 4
SP - 196
EP - 200
JO - Journal of Hand Surgery Global Online
JF - Journal of Hand Surgery Global Online
IS - 4
ER -