Feasibility and Acceptability of a Mobile Application to Monitor Opioid Use and Promote Behavior Modification Following Cesarean Section

Abstract

Opioid misuse and associated negative sequelae, including opioid use disorder and overdose, continue to comprise a public health crisis of epidemic proportions. One opportunity for upstream primary prevention of opioid misuse is the management of opioid use during the postoperative period, including following cesarean section. Research shows that most patients who have a cesarean delivery receive a prescription for opioids on discharge, though limited data exist on postoperative opioid use and misuse. Continuous Precision Medicine (CPM) has developed a mobile application that allows patients to track their pain and usage of both opiates and non-steroidal anti-inflammatory (NSAID) medications and includes elements intended to promote behavior modification through psychoeducation and gamification. The aims of this study were to determine logistical and technological feasibility and acceptability of the mobile application by patients and clinicians and to assess preliminary postoperative opioid use and misuse patterns to inform future directions. Participants (N = 9) were women between the ages of 23 and 41 years old who underwent a repeat cesarean section at an inner-city academic hospital and were without a history of self-reported opioid use. Participants received a tablet loaded with the mobile application and electronic pill packs with the standard postoperative prescription of 14 Roxicodone tablets. On review, 53% of opioids were unused. Four patients took four or fewer Roxicodone pills, with three patients taking none. Additionally, three were noted to have aberrant behavior that was inconsistent with prescribed instructions provided to the patient by the provider. Results of this feasibility study suggest that the CPM mobile application is feasible and acceptable for both patients and practitioners and provides traceability for clinicians to make better-informed decisions regarding patient care. Preliminary data suggest an excess of prescribed narcotics as well as a potential concern for utilization of medication not as prescribed.