Optimizing Acute Post-Operative Dental Pain Management Using New Health Information Technology

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Measuring patient-reported outcomes for pain management after certain dental procedures with a mHealth platform is feasible and improves patient-provider communication, patient-provider relationship, and the ability to manage pain medication prescribing.

Project Details -
Completed

Following dental procedures, the amount of pain patients experience is unpredictable and typically peaks after many hours when the local anesthetic wears off. To mitigate this, dentists pre-emptively prescribe opioids to their patients, despite addiction risk and inferior post-op pain relief compared to non-opioids.

Technology, such as mobile health (mHealth) applications and secure messaging, can effectively collect patient-reported outcome (PRO) data to inform clinical care and promote patient engagement in medicine, but have remained largely unexplored in dentistry. To address this, researchers implemented and evaluated the use of an existing mHealth application (FollowApp.Care) to collect PROs after painful dental procedures, and to determine the impact on patients’ pain experience.

The specific aims of the research were as follows:

  • Customize the design features of FollowApp.Care and assess its capacity to accurately capture PROs.
  • Evaluate the impact of utilizing FollowApp.Care on patients’ postoperative pain experiences and oral health outcomes.
  • Evaluate provider acceptance of FollowApp.Care and its impact on provider performance.

The research team implemented FollowApp.Care at one academic dental institution and one large dental group practice with 54 offices covering three States. The study employed a cluster-randomized experimental study design with: (1) an intervention arm in which patients were prompted to complete two Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity questions through text notifications sent to their smartphone on days 1, 3, 5, and 7; and (2) a control arm in which patients received usual care. All patients were asked three questions on pain interference or management 1 week after their dental procedure. Intervention arm patients also received three questions assessing their experience with FollowApp.Care.

Provider interviews and surveys were conducted to evaluate usability and provider acceptance of the app. While provider and patient acceptance of the mHealth application was high, there was not a significant effect on average pain intensity, pain interference, or satisfaction with pain management for patients using FollowApp.Care, most likely due to low patient-reported average pain levels. Patients and providers indicated improvements in patient-provider communication, patient-provider relationship, postoperative complication management, and ability to manage pain medication prescribing.

Using Patient-Reported Data to Reduce Opioid Use in Dental Patients

Significance and Potential Impact

Actively tracking patient-reported symptoms should decrease the number of patients who are prescribed opioids after surgery upon discharge, as well as the strength of the opioid and length of time they are prescribed.

Harnessing the power of patient-reported data using health IT.

Medical providers are increasingly using PRO data collected via mobile health applications for patient care; however, use of PRO data is largely unexplored in dentistry.

Dentists often preemptively prescribe opioids when the use of non-opiate medications may be more appropriate. Post-op pain generally begins when the patient has returned home and anesthesia from the dental surgery wears off, making pain levels difficult to actively assess and manage. Typically, individuals experience post-op pain for only 3 days, leaving many patients with leftover pills. These remaining pills are a potential source of drug diversion—the transfer of a legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use—and thus a potential contributor to the opioid crisis.

“Patient self-reporting is important for comprehensive pain assessment given pain’s subjective and multi-dimensional nature.”
- Dr. Elsbeth Kalenderian

Dr. Elsbeth Kalenderian, of the University of California San Francisco School of Dentistry and Harvard School of Dental Medicine, with Dr. Muhammad Walji, from the School of Dentistry at the University of Texas Health Science Center at Houston, are leading a team of researchers to study whether pain intensity data collected from patients after dental procedures can help dental providers track patients’ pain more effectively in real time and modify prescription use. Through a user-centered design process, the team is conducting usability testing and workflow analyses with providers and patients to adapt and customize the user interface of an existing mobile health platform called FollowApp.Care. Using a cluster-randomized experimental study, the team will then evaluate the impact of using mobile health technology on patients’ post-op pain experiences and oral health outcomes, as well as provider acceptance of it and its impact on provider performance.