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SeamlessMD Ep. 38 - Study Review: Engaging Patients w/ SMS to understand Post-Op Opioid Consumption

Episode 38 of the SeamlessMD (www.seamless.md) Podcast – Stories from the frontline of Digital Patient Engagement. Show notes 👇 [6:13] Introducing the JAMA-published study, “Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System”; Link to study: https://jamanetwork.com/journals/jama... [7:16] Introducing the main study authors: Anish K. Agarwal, MD, MPH, MS, assistant professor of Emergency Medicine at the University of Pennsylvania, Daniel Lee, MD, MS, Assistant Professor of Urology at the University of Pennsylvania, and Zarina Ali, MD, MS, Assistant Professor of Neurosurgery at the University of Pennsylvania; [8:20] Why we chose to review this particular article as it leverages digital technology (automated text-messaging) to collect patient-reported data and why the paper is important for curbing the opioid crisis; [11:26] Discussing the study design; how Penn maintained their standard of care (with respect to opioid stewardship) and implemented an automated text messaging system to survey patients on post-op day 4, 7, 14, 21, and 28 on three metrics: Pain (0-10), Ability to manage pain (0-10), and number of opioid tablets consumed (for prescription comparison); [13:08] How the study’s opt-in nature inferred a natural selection bias (discussed in the “limitations” section of the paper); [14:49] Discussing the primary and secondary outcomes of the study – Primary: Difference between number of opioids prescribed and patient-reported consumption; Secondary: Self-reported pain scores and ability to manage pain; [15:15] How the automated text message surveys would stop if a patient-reported consuming 0 pills and why this is problematic as it has the potential to skew the results; [16:22] Discussing the characteristics of consenting vs. declining patients, the self-reported pain scores & the self-reported ability to manage pain; How the average pain scores for orthopedic surgery patients was 4.72 on post-op day 4, with a reduction of -0.4 by post-op day 21; How the average pain scores for urology patients was 3.48 on post-op day 4, with a reduction of -1.5 by post-op day 21; [19:05] Discussing the difference in opioid tablets prescribed vs patient-reported consumption; For orthopedic surgery, the median number of opioid tablets prescribed was 20 and the median consumed was 6 (30%); For urology, the median number of opioid tablets prescribed was 7, and the median consumed was 1; Discussing how 9,452 out of the 15,581 (61%) total tablets prescribed went unused (combined orthopedic and urologic surgical procedures) as per patient-report data; [25:11] Why limitations such as sample size, reliability of self-reported data, and the Hawthorne effect are discussed in the “limitations” section of the paper as they are important factors to consider, yet how there remains a large discrepancy between opioid prescription and self-reported consumption; [30:31] Why acting on the data is the most important step in curbing the opioid crisis and how following Pareto’s principle and/or a graduating reduction of prescription practice may be a step in the right direction while maintaining patient safety and ethics; [43:07] How the University of Michigan has done tremendous work reducing opioid prescriptions by setting accurate patient expectations of pain – weighing Quality of Life on a long-term scale, with heavy consideration for the potential of negative effects from opioids;