Table 5.

Clinical guidelines.

Type outcomes	Study design	Number of studies	Findings
Provider behavior *Low	Descriptive/before-after	12	Increase in reading and/or applying guideline (Franklin et al., 2013a)SS Prescribes higher doses less often (Franklin et al., 2013a)NT Low percentage of providers with pharmacist collaborative drug therapy agreement (Franklin et al., 2013a)NT Decrease in/less opioid prescribing (Fox et al., 2013; Franklin et al., 2013a; Franklin et al., 2013b; Gordon et al., 2000)NT Increase in/higherprevalence of correct dose and frequency (Humphries et al., 1997)SS No differences in dose or long-acting opioid use for at-risk patients (Morasco et al., 2011)NS More likely to prescribe ER formulation for chronic episodes, but still underutilized (Victor et al., 2009)SS Limited actual use of recommended practices (e.g., treatment agreement, assessment of pain, urinetesting) (Cochellaand Bateman, 2011; Krebs et al., 2011; Morse et al., 2012; Porucznik et al., 2013; Sekhon et al., 2013)NT
	Time series	1	Less likely to prescribe high dose among new users (Garg et al., 2013)SS
	RCT	2	No changes in prescribing frequency (McCracken et al., 2012)NS Increase in self-report use of guidelines (McCracken et al., 2012)SS No differences between clinicians in the Assistance with Pain Treatment intervention and clinicians in the treatment as usual group (overall limited use of recommended practices) (Corson et al., 2011)NS
Patient behavior	Descriptive/before-after	0
*Low	Time series	1	Lower number of incident users who become chronic and statistically significant reduced likelihood of receiving high dose opioids with incident users (Garg et al., 2013)SS
	RCT	0
Health outcomes *Very low	Descriptive/before-after	3	Decrease in ED visits (Fox et al., 2013)NT Decrease in deaths (Cochella and Bateman, 2011; Franklin et al., 2013b)NT
	Time series	1	No changes in poisonings or opioid adverse effects (Fulton-Kehoe et al., 2013)NS
	RCT	0

Note:

^SS= Tested and statistically significant.

^NS= Tested and not statistically significant.

^NT= No statistical testing conducted.

^*= Evidence level.