Background Between 1999–2016 in the U.S., more than 200,000 drug overdose deaths occurred involving prescription opioids. Emergency departments (EDs) contribute to the problem; 42% of opioids prescribed in EDs are misused. Interventions aimed at providers decrease rates of ED opioid prescribing but little is know about how to reduce patient demand.
Objectives To evaluate feasibility of patient decision aid (PDA) on use of prescripedopioids among sample of adult patients in one Maryland and one West Virginia ED; to determine impact of PDA on patients’ knowledge, decisional conflict, preference for opioid, and storage and disposal practices.
Methods Participants were randomized to intervention group (IG, N=65) or control group (CG, N=59). After triage and before seeing treating clinician, IG participants completed PDA and CG participants completed time-matched Health Risk Assessment (HRA) on iPad. Data were collected at enrollment (baseline), after completing PDA/HRA (post-test), after seeing treating clinician (discharge), and 6-weeks after discharge (follow-up). Findings. From baseline to discharge, no significant difference emerged between IG and CG in patient comfort with the three different pain treatment options (opioid, non-opioid, and no prescription) or in knowledge scores. IG patients reported significantly greater reduction in decisional conflict about pain medication preference, and felt more informed about options. No difference emerged in proportions who received opioid prescription between study groups, or in shared decision-making about their prescription. Among 16 patients who were discharged with opioid prescription and got it filled, 31% stored with latch/lock and 25% disposed inappropriately.
Conclusions and Policy Implications While the PDA was well received by patients and easy to integrate into busy ED settings, it did not significantly reduce prescribing. Patients’ decisional conflict and feeling informed were significantly positively impacted. More work is needed to identify effective ways to reduce demand and educate patients about opioid safe use, storage and disposal.
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