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

Project Details - Ongoing

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Adequate dental pain management is challenging, and its continuous assessment is crucial to minimize patients’ pain experiences. Patient self-report is a critical part of comprehensive pain assessment, given pain’s subjective and multi-dimensional nature. Dental patients are unable to predict their pain following procedures until they are experiencing it at home many hours later, and dental offices are closed. This has led to an over-reliance on pre-emptively prescribed opioids by dental providers. Innovative mobile health (mHealth) technologies that allow real-time tracking of patients’ symptoms, functional status, and quality of life can provide dental professionals with vital data for more informed treatment and care decisions, as well as increased patient engagement.

This project will implement Followapp.Care, a dental patient reported outcomes (PROs) system, using mobile phone and text messaging to track two important PROs: pain intensity and pain experience. By actively tracking symptoms, providers will have an opportunity to modify pain medication prescriptions, thereby eliminating needless suffering, reducing the occurrence or severity of post-operative complications, and enhancing the overall care experience. The ultimate goals of the project are to enhance patient and physician experience, improve patient outcomes, and reduce per capita costs.

The specific aims of the project are as follows:

  • Customize the design features of Followapp.Care and assess its capacity to accurately capture patient-reported outcomes. 
  • Evaluate the impact of utilizing Followapp.Care on patients’ post-operative pain experiences and oral health outcomes. 
  • Evaluate provider acceptance of Followapp.Care and its impact on provider performance. 

Investigators will employ a cluster-randomized study. Patients in the intervention arm will be prompted to complete a pain intensity scale through text messages at pre-defined time intervals, while control arm patients receive usual care. Surveys will evaluate patients’ experience and providers’ acceptance using the application. By collecting PROs in a timely and usable way, investigators expect to help dentists enhance their practice performance and reduce the burden of unnecessary opioid prescriptions on society. Followapp.Care has the potential to be deployed across a wide range of pre- and post-treatment monitoring tasks in various ambulatory care settings, thereby fostering inter-professional mHealth collaborations.

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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.

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