Evaluation of the Acceptability and Usability of a Decision Support System to Encourage Safe and Effective Use of Opioid Therapy for Chronic, Noncancer Pain by Primary Care Providers

Objective: To study the factors that influence the use of opioids in the management of chronic noncancer pain (CNCP) by primary care providers (PCPs) for patients returning from a pain specialist.Design: A survey of PCPs.Setting: Two physician groups in the Minneapolis-St. Paul metropolitan area.Participants: Two seventy-six PCPs surveyed and 80 surveys returned. Main outcome measures: Participants rated the importance of specific concerns regarding the role of pain specialists and the use of opioids in the management of CNCP. Past experience with pain specialists, comfort using opioids, and opinions regarding a trilateral opioid agreement were also examined.Results: The top concerns for PCPs were as follows: the use of opioids in patients with chemical dependency or psychological issues, the escalation of opioid dosing, and the use of opioids in pain states without objective findings. They also ranked highly the importance of coordinating the return of patients from a pain specialist with explicit opioid instructions and the availability of consultation by phone or a timely follow-up visit. PCPs were supportive of the concept of a trilateral opioid agreement.Conclusions: PCPs have significant concerns regarding the prescribing of opioids in CNCP. They desire closer collaboration with pain specialists, including more explicit plans of care when patients are transferred back to them. The trilateral agreement may provide one framework for better collaboration.

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Factors associated with participation and nonparticipation in a VA Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP)

Journal of Opioid Management ◽

10.5055/jom.2020.0566 ◽

2020 ◽

Vol 16 (3) ◽

pp. 179-188

Author(s):

Amber Martinson, PhD ◽

Amanda Kutz, PhD ◽

William Marchand, MD ◽

Julie Carney, RN ◽

Jamie Clinton-Lont, MS, CNP

Keyword(s):

Mental Health ◽

Primary Care ◽

Rural Areas ◽

Monitoring Program ◽

Primary Care Providers ◽

Care Providers ◽

Pain Education ◽

Chronic Noncancer Pain ◽

Medical Diagnoses ◽

Noncancer Pain

Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we compared demographic and health characteristics between participants and nonparticipants drawn from the same defined population.Design/Methods: Retrospective chart review comparing participants and nonparticipants in terms of two categories of variables: (1) demographic characteristics and (2) physical/mental health characteristics.Setting: VA Primary Care.Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy 3 months being managed in primary care.Results: A total of 749 veterans (424 participants in PC-POP and 325 nonparticipants) were included in the final analysis. Results showed that nonparticipation was associated with more widespread musculoskeletal pain, low back pain, anxiety, higher mortality, and rural areas. Participation was associated with more medical diagnoses overall, hypertension, sleep apnea, fibromyalgia, peripheral nerve pain, depression, and female gender. Other demographic and physical/mental health variables did not significantly differ between the groups.Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, programs are needed to assist primary care providers to meet the rigorous requirements of guideline concordant care. The current study examined participation factors in such a program and found that certain veterans were less likely to participate than others. Identifying such veterans at the outset, in combination with intentional recruitment efforts and individualized interventions, may promote entry into PC-POP.

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Chronic opioid therapy issues associated with opioid abuse potential

Journal of Opioid Management ◽

10.5055/jom.2009.0029 ◽

2018 ◽

Vol 5 (5) ◽

pp. 287 ◽

Cited By ~ 22

Author(s):

Howard S. Smith, MD ◽

Kenneth L. Kirsh, PhD ◽

Steven D. Passik, PhD

Keyword(s):

Primary Care Providers ◽

The United States ◽

Opioid Therapy ◽

Due Diligence ◽

Care Providers ◽

Chronic Opioid Therapy ◽

Chronic Noncancer Pain ◽

Potential Risk Factors ◽

Noncancer Pain ◽

Documentation Tool

Chronic opioid therapy continues to be an important “mainstream” option for the relief of pain, despite continued debate over the efficacy and safety of utilizing opioids with chronic noncancer populations. With this increase in utilization for medical purposes, the authors have also experienced a troubling rise in the abuse and diversion of prescription opioids. Providers should note this relationship and always perform due diligence when assessing whether a patient with chronic noncancer pain is an appropriate candidate for opioid therapy based on potential risk factors. Because of the relative shortage of board-certified pain practitioners in the United States, much of the practice of pain management falls on primary care providers, who might feel uncomfortable or overwhelmed when facing these issues. To this end, a set of guidelines are discussed to promote an approach to chronic noncancer pain utilizing “universal precautions” principles. In addition, several risk tools are evaluated, including the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), the Opioid Risk Tool (ORT), and the Pain Assessment and Documentation Tool (PADT). Finally, discussion is presented regarding what practices seen in opioid prescribing can be considered “in-or-out” of the mainstream box.

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Knowledge, Attitudes and Beliefs about Chronic Noncancer Pain in Primary Care: a Canadian Survey of Physicians and Pharmacists

Pain Research and Management ◽

10.1155/2014/760145 ◽

2014 ◽

Vol 19 (5) ◽

pp. 241-250 ◽

Cited By ~ 17

Author(s):

Lyne Lalonde ◽

Vincent Leroux-Lapointe ◽

Manon Choinière ◽

Elisabeth Martin ◽

David Lussier ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Treatment Plan ◽

Primary Care Providers ◽

Initial Assessment ◽

Attitudes And Beliefs ◽

Care Providers ◽

Chronic Noncancer Pain ◽

Definition Of ◽

Noncancer Pain

BACKGROUND: Primary care providers’ knowledge, attitudes and beliefs (KAB) regarding chronic noncancer pain (CNCP) are a barrier to optimal management.OBJECTIVES: To evaluate and identify the determinants of the KAB of primary care physicians and pharmacists, and to document clinician preferences regarding the content and format of a continuing education program (CEP).METHOD: Physicians and pharmacists of 486 CNCP patients participated. Physicians completed the original version of the KnowPain-50 questionnaire. Pharmacists completed a modified version. A multivariate linear regression model was developed to identify the determinants of their KAB.RESULTS: A total of 137 of 387 (35.4%) physicians and 110 of 278 (39.5%) pharmacists completed the survey. Compared with the physicians, the pharmacists surveyed included more women (64% versus 38%) and had less clinical experience (15 years versus 26 years). The mean KnowPain-50 score was 69.3% (95% CI 68.0% to 70.5%) for physicians and 63.8% (95% CI 62.5% to 65.1%) for pharmacists. Low scores were observed on all aspects of pain management: initial assessment (physicians, 68.3%; pharmacists, 65.4%); definition of treatment goals and expectations (76.1%; 61.6%); development of a treatment plan (66.4%; 59.0%); and reassessment and management of longitudinal care (64.3%; 53.1%). Ten hours of reported CEP sessions increased the KAB score by 0.3 points. All clinicians considered a CEP for CNCP to be essential. Physicians preferred an interactive format, while pharmacists had no clear preferences.CONCLUSION: A CEP to improve primary care providers’ knowledge and competency in managing CNCP, and to reduce false beliefs and inappropriate attitudes regarding CNCP is relevant and perceived as necessary by clinicians.

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Primary care survey of the value and effectiveness of the Washington State Opioid Dosing Guideline

Journal of Opioid Management ◽

10.5055/jom.2011.0083 ◽

2017 ◽

Vol 7 (6) ◽

pp. 427-433 ◽

Cited By ~ 16

Author(s):

Josiah S. Morse, MPH ◽

Hal Stockbridge, MD, MPH ◽

Kathleen B. Egan, MPH ◽

Jaymie Mai, PharmD ◽

Thomas Wickizer, PhD ◽

...

Keyword(s):

Primary Care ◽

Drug Testing ◽

Primary Care Providers ◽

Washington State ◽

Care Providers ◽

Convenience Sample ◽

Chronic Noncancer Pain ◽

Administrative Leaders ◽

Noncancer Pain ◽

And Function

Purpose: To evaluate the acceptability and usefulness of the Washington State Opioid Dosing Guideline (Guideline) developed for primary care providers for the treatment of chronic noncancer pain. The Guideline contains innovative tools, such as an online dosing calculator, and recommendations to assist providers, including a “yellow flag” threshold of 120 mg/d morphine equivalent dose (MED) at which specialty consultation is recommended.Methods: Using a convenience sample, an anonymous web-based survey was conducted among primary care providers in Washington (WA) state. Physician/administrative leaders in four regional and two statewide healthcare systems and associations distributed the electronic links to primary care providers in their organizations.Results: Six hundred fifty-five (n) providers completed the survey representing 20 percent of the total number contacted. The majority (89 percent) of providers in this sample treat chronic pain patients, and more than half (54 percent) have frequent concerns about addiction, tolerance, and diversion. Forty-five percent had read and applied the Guideline in their practice. The majority of these providers found the Guideline to be helpful and 86 percent find the threshold of 120 mg/d MED dose reasonable or too high. Some key best practices such as tracking pain and function using structured instruments and use of urine drug testing are infrequently used.Conclusions: Results from this survey suggest that the recommendations and tools given in the Guideline, including the threshold of 120 mg/day MED dose, are acceptable and useful to a large majority of primary care providers in WA state. Substantial additions to the Guideline based on needs identified in this survey were added in June 2010 and wider dissemination is planned.

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Perceived Effectiveness of Artificial Intelligence based Decision Support System in a Clinical Setting: A Systematic Literature Review (Preprint)

10.2196/preprints.19282 ◽

2020 ◽

Author(s):

Avishek Choudhury

Keyword(s):

Artificial Intelligence ◽

Decision Making ◽

Decision Support ◽

Literature Review ◽

Decision Support System ◽

Support System ◽

Clinical Setting ◽

Clinical Decision Making ◽

Theoretical Perspective ◽

Care Providers

UNSTRUCTURED Objective: The potential benefits of artificial intelligence based decision support system (AI-DSS) from a theoretical perspective are well documented and perceived by researchers but there is a lack of evidence showing its influence on routine clinical practice and how its perceived by care providers. Since the effectiveness of AI systems depends on data quality, implementation, and interpretation. The purpose of this literature review is to analyze the effectiveness of AI-DSS in clinical setting and understand its influence on clinician’s decision making outcome. Materials and Methods: This review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta- Analyses reporting guidelines. Literature will be identified using a multi-database search strategy developed in consultation with a librarian. The proposed screening process consists of a title and abstract scan, followed by a full-text review by two reviewers to determine the eligibility of articles. Studies outlining application of AI based decision support system in a clinical setting and its impact on clinician’s decision making, will be included. A tabular synthesis of the general study details will be provided, as well as a narrative synthesis of the extracted data, organised into themes. Studies solely reporting AI accuracy an but not implemented in a clinical setting to measure its influence on clinical decision making were excluded from further review. Results: We identified 8 eligible studies that implemented AI-DSS in a clinical setting to facilitate decisions concerning prostate cancer, post traumatic stress disorder, cardiac ailment, back pain, and others. Five (62.50%) out of 8 studies reported positive outcome of AI-DSS. Conclusion: The systematic review indicated that AI-enabled decision support systems, when implemented in a clinical setting and used by clinicians might not ensure enhanced decision making. However, there are very limited studies to confirm the claim that AI based decision support system can uplift clinicians decision making abilities.

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Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

Applied Clinical Informatics ◽

10.1055/s-0040-1715895 ◽

2020 ◽

Vol 11 (04) ◽

pp. 635-643

Author(s):

Joan S. Ash ◽

Dian Chase ◽

Sherry Baron ◽

Margaret S. Filios ◽

Richard N. Shiffman ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Primary Care Providers ◽

Care Providers ◽

Technical Feasibility ◽

Primary Care Settings ◽

Worker Health ◽

Operational Issues

Abstract Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

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Treatment of chronic noncancer pain in patients on opioid therapy in primary care: A retrospective cohort study

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163519887766 ◽

2019 ◽

Vol 153 (1) ◽

pp. 52-58

Author(s):

Arden R. Barry ◽

Chantal E. Chris

Keyword(s):

Primary Care ◽

Cohort Study ◽

Back Pain ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Opioid Therapy ◽

Opioid Agonist ◽

Chronic Noncancer Pain ◽

Opioid Dose ◽

Noncancer Pain

Background: This study sought to characterize the real-world treatment of chronic noncancer pain (CNCP) in patients on opioid therapy in primary care. Methods: A retrospective cohort study from 2014-18 was conducted at a multidisciplinary primary care clinic in Chilliwack, British Columbia. Included were adults on daily opioid therapy for CNCP. Patients receiving palliative care or ≤1 visit were excluded. Outcomes of interest included use of opioid/nonopioid pharmacotherapy, number/frequency of visits and proportion of patients able to reduce/discontinue opioid therapy. Results: Seventy patients (mean age 53 years, 53% male, 51% back pain) were included. Median follow-up was 6 visits over 12 months. Sixty-two patients (89%) reduced their opioid dose, 6 patients had no change and 2 patients required a dose increase. Mean opioid dose was reduced from 183 to 70 mg morphine equivalents daily. Twenty-four patients (34%) discontinued opioid therapy, 6 patients (9%) transitioned to opioid agonist therapy and 6 patients (9%) breached their opioid treatment agreement. Nonopioid pharmacotherapy included nonsteroidal anti-inflammatory drugs (64%), gabapentinoids (63%), tricyclic antidepressants (56%) and nabilone (51%). Discussion: Over half of patients were no longer on opioid therapy by the end of the study. Most patients had a disorder (e.g., back pain) for which opioids are generally not recommended. Overall mean opioid dose was reduced from baseline by approximately 60% over 1 year. Lack of access to specialized pain treatments may have accounted for high nonopioid pharmacotherapy usage. Conclusions: This study demonstrates that treatment of CNCP and opioid tapering can successfully be achieved in a primary care setting. Can Pharm J (Ott) 2020;153:xx-xx.

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Developing an Evidence-Based Clinical Decision-Support System to Enhance Prosthetic Prescription

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101116 ◽

2021 ◽

Vol 10 (1) ◽

pp. 121-125

Author(s):

Pratima Saravanan ◽

Jessica Menold

Keyword(s):

Decision Making ◽

Decision Support ◽

Decision Support System ◽

Gait Analysis ◽

Support System ◽

Patient Specific ◽

Evidence Based ◽

Extensive Literature ◽

Analysis Tool ◽

Care Providers

With the rapid increase in the global amputee population, there is a clear need to assist amputee care providers with their decision-making during the prosthetic prescription process. To achieve this, an evidence-based decision support system that encompasses existing literature, current decision-making strategies employed by amputee care providers and patient-specific factors is proposed. Based on an extensive literature review combined with natural language processing and expert survey, the factors influencing the current decision-making of amputee care providers in prosthetic prescription were identified. Following that, the decision-making strategies employed by expert and novice prosthetists were captured and analyzed. Finally, a fundamental understanding of the effect gait analysis has on the decision-making strategies of prosthetists was studied. Findings from this work lay the foundation for developing a real-time decision support system integrated with a portable gait analysis tool to enhance prescription processes. This is critical in the low-income countries where there is a scarcity of amputee care providers and resources for an appropriate prescription.

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