Table 1

Eligibility criteria for overview of systematic reviews of the effect of interventions targeting behaviours of physician prescribers of opioids for adult chronic non-cancer pain on prescriber behaviour and patient and population health

PICO elementInclusionExclusion
PopulationThis overview will be restricted to systematic reviews of studies conducted in healthcare professionals who prescribe opioids, with a focus on physician opioid prescribers (medical doctors who prescribe opioids).
Eligible systematic reviews will include primary studies evaluating interventions targeted exclusively at physician opioid prescribers or targeted at multiple healthcare professional populations including physician opioid prescribers. Reviews of interventions targeted at multiple healthcare professional populations must include studies in which these interventions are delivered specifically or in part to physician opioid prescribers.
Reviews that include some studies in eligible populations and some studies in ineligible populations will be included provided they report at least one outcome specific to an eligible population.		Reviews limited to studies of interventions delivered exclusively to non-physician healthcare professionals (dentists, nurse practitioners, physician assistants, pharmacists, etc.)
Reviews limited to studies of interventions delivered exclusively or in part to patients (eg, structured pain management programmes).
InterventionWe will include systematic reviews of any type of intervention(s) aimed at impacting opioid prescribing behaviour, with a focus on those aimed at impacting opioid prescribing behaviour for adult CNCP in an outpatient setting. Examples of eligible interventions include PDMPs, prescriber education (eg, online courses, workshops, and tele-mentoring programmes such as Project ECHO), pain clinic legislation, clinical guidelines (eg, the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain) evaluated as interventions and interventions relating to naloxone coprescription with opioids (eg, naloxone education for prescribers and naloxone coprescription requirements).
Eligible systematic reviews will include primary studies of interventions targeted exclusively at impacting opioid prescribing behaviour for adult CNCP in an outpatient/mixed setting or targeted at impacting prescribing behaviour for multiple opioid prescription indications including adult CNCP in an outpatient/mixed setting (eg, adult CNCP in addition to other pain indications or opioid use disorder). For interventions targeting multiple prescription indications, eligible reviews must include primary studies specific to opioid prescribing in the context of adult CNCP or studies in a mixed prescription indication context that includes adult CNCP. For interventions targeting a mixed prescription setting, eligible reviews will include primary studies in an exclusively outpatient setting or in a mixed outpatient/inpatient setting.
Reviews that include some studies of eligible interventions and some studies of ineligible interventions will be included provided they report at least one outcome specific to an eligible intervention or group of interventions.		Reviews limited to studies of interventions not aimed at impacting opioid prescribing behaviour.
Reviews limited to studies exclusively targeting non-adult CNCP prescription indications (eg, acute pain, post-surgical pain, cancer pain, paediatric CNCP, opioid use disorder) or palliative pain management.
Reviews limited to studies exclusively targeting prescribing in an inpatient setting.
Reviews that do not report any outcomes specific to an eligible intervention or group of interventions.
ComparatorsEligible systematic reviews may include one or both of the following types of primary studies:

  1. Comparative studies that evaluated intervention effect against no intervention, usual care procedures or other active (eg, prescriber education vs clinical guideline implementation) or control (eg, attention control) interventions

  2. Non-comparative studies (eg, time series without comparator).

 
OutcomesEligible systematic reviews will report at least one outcome pertaining to intervention effect on patient and population health or opioid prescribing behaviour.
Eligible patient and population health outcomes will include:

  1. Changes in patient-reported health and pain outcomes (eg, changes in patient-reported physical functioning, quality of life and pain outcomes, including both measures of pain intensity/severity and pain interference with functioning).

  2. Changes in pharmaceutical or non-pharmaceutical opioid (eg, heroin)-related morbidity and mortality (eg, changes in prevalence or incidence of fatal and non-fatal opioid overdose, opioid-related hospitalisations and opioid-related emergency department visits, overall or by specific drug; changes in incidence of opioid abuse treatment initiation or inpatient admissions for opioid abuse treatment).

  3. Changes in prevalence or incidence of self-reported non-medical prescription opioid use or non-pharmaceutical opioid use.


Eligible opioid prescribing behaviour outcomes will include:

  1. Changes in opioid prescribing practices (eg, changes in incidence or prevalence of opioid prescriptions, overall, by specific drug or by release type (eg, short-acting vs long-acting/extended release); changes in average duration or dosage of individual opioid prescriptions; changes in coprescription of naloxone with opioids (eg, changes in incidence or number of naloxone prescriptions); changes in number of overlapping opioid and benzodiazepine prescriptions (eg, changes in number of patients with benzodiazepine and opioid prescriptions overlapping by at least one common day)).

  2. Changes in rates of prescribing of and referrals to alternative pain management therapies (eg, changes in number of non-opioid analgesic prescriptions, changes in number of referrals to physical therapy).

  3. Changes in intervention adherence, where these constitute a measure of intervention effect and a change in prescribing behaviour (eg, changes in prescriber adherence to CNCP opioid prescribing guideline recommendations following an educational intervention designed to improve prescriber adherence to said recommendations).

Systematic reviews that exclusively report outcomes not related to intervention effect on patient and population health or opioid prescribing behaviour, for example,

  • Feasibility

  • Acceptability (including healthcare professional and public perceptions of and attitudes towards interventions)

  • Cost-effectiveness

  • Intervention adherence (where this does not constitute a measure of intervention effect)

Study designSystematic reviews with or without meta-analysis. Reviews must meet the following criteria to be considered systematic:

  1. Methods are described, including a systematic search with inclusion/exclusion criteria.

  2. Formal risk of bias assessment of included studies was performed (eg, using the Cochrane Risk of Bias tool), with individual results reported for each study and item/domain of the tool.


We will include systematic reviews with or without meta-analysis. Data may be derived from any primary study type (eg, experimental or observational) conducted in humans.		Any review or study that does not meet the criteria of a systematic review, including:

  • Overviews of systematic reviews

  • Non-systematic reviews

  • Primary studies

  • Commentaries

Forms of publicationLanguage: English*
Systematic review abstracts and conference proceedings will be eligible provided they meet the aforementioned systematic review criteria and include sufficient detail to enable extraction of risk of bias assessments per study and tool domain/item.
*English-language abstracts of non-English language publications will not be eligible for inclusion, as records will be assessed for eligibility on the basis of the most complete version of the publication.		Non-English language publications

  • CNCP, chronic non-cancer pain; ECHO, Extension for Community Healthcare Outcomes; PDMP, prescription drug monitoring programmes.