Post-Discharge Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery

NCT ID: NCT03536065

Last Updated: 2020-07-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

443 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-08-01

Study Completion Date

2019-03-01

Brief Summary

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ORIOLES is a non-randomized, pre-post intervention study designed to improve quality of opioid prescribing and use after discharge for patients undergoing urologic surgery. The study will initially focus on a pre-defined cohort of patients undergoing radical prostatectomy. After the predefined study period for the pre-intervention arm, a three-part intervention is employed to assess the effect on opioid prescribing and use in the post-intervention arm. Pending results, the intervention may be applied to all surgeries in the department for routine clinical care.

Detailed Description

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The goal of the study is to reduce the amount of opioid analgesia prescribed after urologic surgery in the Department of Urology at Johns Hopkins. The initiative focuses on patients undergoing surgery for prostate cancer with radical prostatectomy including patients enrolled in IRB00123618/NCT03006562. The pre-intervention arm will consist of patients enrolled August 2017 to January 2018. The intervention arm will consist of patient enrolled January 2018 to completion of the study.

The intervention consists of a information discharge sheet, a standardized prescribing guideline at discharge, and nurses providing improved education for patients at discharge about appropriate use of opioid medication, routes for disposal, and potential side effects. Data on prescriptions written (amount and type of mediation) and use of opioid and other pain medication after surgery will be compared before and after the quality improvement initiative is started. Outcomes are assessed via 30-day phone call follow-up with data on perioperative outcomes, postoperative medication use, and symptoms already assessed in IRB00123618/NCT03006562. At the completion of the pre-intervention arm, providers in the urology department are informed about the average and distribution of usage of post-discharge opioids. Education and standardized prescribing (allowing for provider judgment) may help reduce/personalize the amount of opioids prescribed at discharge to reduce wasted medication entering circulation. The initiative may then be expanded to encompass all surgeries in the department to reduce opioid prescribing and use for routine clinical care.

Conditions

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Prostate Cancer Opioid Use

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

Pre-Post Study Design with Non-Pharmacologic Intervention
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Pre-Intervention

Current practice (unchanged)

Group Type ACTIVE_COMPARATOR

Current Care

Intervention Type BEHAVIORAL

Current unchanged care provided; unchanged provider prescribing and unchanged education of patients prior to intervention

Post-Intervention

Reduction of opioid prescription based on Pre-Intervention data, implementation of a discharge sheet and nursing education.

Group Type EXPERIMENTAL

Opioid Reduction Intervention

Intervention Type BEHAVIORAL

Patient education discharge sheet, nursing education, opioid prescription reduction based on Pre-Intervention data

Interventions

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Opioid Reduction Intervention

Patient education discharge sheet, nursing education, opioid prescription reduction based on Pre-Intervention data

Intervention Type BEHAVIORAL

Current Care

Current unchanged care provided; unchanged provider prescribing and unchanged education of patients prior to intervention

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* All patients diagnosed with prostate cancer and enrolled in NCT03006562

Exclusion Criteria

* Patients not undergoing radical prostatectomy (for the primary pre-post ORIOLES study)
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Johns Hopkins University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Amin S Herati, MD

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins University

Locations

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Johns Hopkins Hospital

Baltimore, Maryland, United States

Site Status

Countries

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United States

References

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Huang MM, Su ZT, Becker REN, Pavlovich CP, Partin AW, Allaf ME, Patel HD. Complications after open and robot-assisted radical prostatectomy and association with postoperative opioid use: an analysis of data from the PREVENTER trial. BJU Int. 2021 Feb;127(2):190-197. doi: 10.1111/bju.15172. Epub 2020 Aug 17.

Reference Type BACKGROUND
PMID: 32654363 (View on PubMed)

Patel HD, Srivastava A, Patel ND, Faisal FA, Ludwig W, Joice GA, Schwen ZR, Allaf ME, Han M, Herati AS. A Prospective Cohort Study of Postdischarge Opioid Practices After Radical Prostatectomy: The ORIOLES Initiative. Eur Urol. 2019 Feb;75(2):215-218. doi: 10.1016/j.eururo.2018.10.013. Epub 2018 Oct 21.

Reference Type RESULT
PMID: 30352714 (View on PubMed)

Patel HD, Faisal FA, Patel ND, Pavlovich CP, Allaf ME, Han M, Herati AS. Effect of a prospective opioid reduction intervention on opioid prescribing and use after radical prostatectomy: results of the Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) Initiative. BJU Int. 2020 Mar;125(3):426-432. doi: 10.1111/bju.14932. Epub 2019 Nov 15.

Reference Type RESULT
PMID: 31643128 (View on PubMed)

Other Identifiers

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IRB00162359

Identifier Type: -

Identifier Source: org_study_id

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