Clinical decision support as an opioid de-implementation tool
post-extraction pain, pain
At a basic level, the decision of whether to prescribe an opioid to a given patient rests on the provider. Therefore, provider-level interventions are needed to change what has become an entrenched prescribing practice. One approach to changing provider behavior is the deployment of a clinical decision support (CDS) system. CDS offers real-time guidance and resources to healthcare providers to facilitate the delivery of the best evidence care for a specific patient. However, because opioid prescribing for post-extraction pain became very common, many patients may come to the dentist expecting that they will receive opioid analgesics to manage their pain [In order to align dental practices with current best evidence guidelines, it is necessary to de-implement the widespread use of opioids, while implementing the use of non-opioid approaches to managing post-extraction pain using the alternative of the NSAID-acetaminophen combination. De-implementation research shares many characteristics with traditional implementation science, but there are aspects that differ in the framing of research questions and de-implementation strategies [In the current study, we sought to test the effectiveness of CDS with and without patient education, relative to usual care, in de-implementing opioid prescribing for dental extractions at a large multi-clinic dental system in the Midwest.