Barriers, facilitators, and recommendations to increase the use of a clinical decision support tool for managing chronic pain in primary care.

Int J Med Inform

Department of Health Policy & Management Indiana University, Indianapolis, IN, United States; Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States. Electronic address:

Published: December 2024

AI Article Synopsis

  • Primary care providers (PCPs) struggle with disorganized information in electronic health records (EHR) while managing patients with chronic pain, which can be improved with clinical decision support (CDS) tools like the Chronic Pain OneSheet, designed to streamline patient information and support treatment decisions.
  • In a study involving interviews with PCPs who use OneSheet, barriers such as limited time, resistance to new workflows, and complex displays were identified, while facilitators included its role as a central data hub and ease of access to important features.
  • Recommendations to enhance OneSheet usage include simplifying displays, customizing features, and allowing broader access for patients and team members, emphasizing the need for CDS tools to align with PCP workloads and tasks.

Article Abstract

Background And Objective: Primary care providers (PCPs) use poorly organized patient information in electronic health records (EHR) within a limited time when treating patients with chronic pain. Clinical decision support (CDS) tools assist PCPs by synthesizing patient information and prompting guideline-concordant treatment decisions. A CDS tool- Chronic Pain OneSheet was developed through a user-centered design process to support PCP's decision-making for patients with chronic noncancer pain. OneSheet aggregates relevant patient information in one place in the EHR. OneSheet also guides PCPs in completing guideline-recommended opioid risk management tasks, tracking patient treatments, and documenting pain-related symptoms. Our objective was to identify barriers, facilitators, and recommendations to increase OneSheet use for chronic noncancer pain management in primary care.

Methods: We conducted 19 qualitative interviews with PCPs from two academic health systems who had access to OneSheet in their EHR. Interview transcripts were coded to identify common themes using a modified thematic approach.

Results: PCPs identified several barriers to using OneSheet, including limited time to address patient needs associated with multiple chronic conditions, resistance to changing established workflows, and complex OneSheet display. PCPs reported several facilitators to using OneSheet, such as OneSheet's ability to serve as a hub for chronic pain data, easy access to features that facilitate completing mandatory tasks and improved planning for certain patient visits. PCPs recommended prioritizing access to commonly used features, adding display customization capabilities, and expanding access to patients and other team members to increase OneSheet use.

Conclusion: Our findings highlight the importance of acknowledging the PCP workflow and task load when designing CDS tools. Future CDS tools should balance the extent of information provided with assisting PCPs to fulfill mandatory tasks. Expanding CDS tools to multiple care team members and patients can also lead to higher use by facilitating data entry, leading to more streamlined care delivery.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575684PMC
http://dx.doi.org/10.1016/j.ijmedinf.2024.105649DOI Listing

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