The aim of this study is to estimate the impact of providing personalized prescribing data and educational materials on opioid prescribing to dentists in British Columbia, Canada.
The main research questions are:
1. What is the impact of an intervention on the use of opioids for dental pain? The intervention includes a personalized prescribing report (a "Portrait"), brief educational summary, and patient education materials; and 2. Does the impact of the intervention increase when dentists are also invited to attend facilitated audit-and-feedback group sessions and to develop a practice improvement plan? Using administrative health data, the prescribing of those in different combinations of materials in the Early Group will be compared to those in the Delayed Group to estimate the impact of the materials on prescribing by the dentists.
Registered with the British Columbia Medical Services Plan (MSP) as being in active practice;
Have a valid mailing address in British Columbia; and
Issued ≥10 prescriptions dispensed at community pharmacies between January 5, 2025 and January 5, 2026, as identified in PharmaNet claims data.
Received an opioid prescription from an eligible dentist during the study period (January 6, 2026 to January 6, 2027);
Had a medication dispensed under Plan P in the 12 months prior to the opioid prescription; or
Filled a prescription for opioid agonist therapy (OAT) within 180 days prior to the opioid prescription.
Sequential
Regular intervention
BehavioralThe "regular" intervention bundle consists of a personalized prescribing "Portrait" showing dentists their opioid prescribing volume and duration over the past five years compared with the provincial median. The Portrait is accompanied by a Therapeutics Letter summarizing evidence-based recommendations for dental pain management, emphasizing that NSAIDs with or without acetaminophen provide similar or better pain control than opioids and are associated with fewer adverse events. Dentists also receive a patient education handout addressing common questions about opioid use for dental pain.
Enhanced intervention
BehavioralFor the "enhanced" intervention bundle, dentists receive all components of the regular intervention, plus and invitation to participate in facilitated peer audit-and-feedback group sessions to review prescribing data, identify practice gaps, develop improvement strategies, and commit to change. Participants also receive an updated personalized Portrait (updated data) at approximately six months, followed by additional facilitated sessions to review new data and reassess practice enhancement strategies.
The number of opioid prescriptions per dentist
The primary outcome is the change from baseline in the number of opioid prescriptions per dentist. The primary measures of effect will be absolute differences between trial arms, differences in prescribing trends over time, and difference-in-differences estimates comparing the intervention period with the pre-intervention period.
Total morphine milligram equivalents (MME) prescribed per dentist
The primary outcome is the change from baseline in the total morphine milligram equivalents (MME) prescribed per dentist. The primary measures of effect will be absolute differences between trial arms, differences in prescribing trends over time, and difference-in-differences estimates comparing the intervention period with the pre-intervention period.
Rate ratios between trial arms
Secondary measures of effect will include relative measures (rate ratios) comparing trial arms.
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University of British Columbia
Lead sponsor
Ministry of Health, British Columbia
Collaborator
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