Pain Management in Primary Care: A Randomized Controlled Trial of a Computerized Decision Support Tool.
Adult
Aged
Analgesics, Non-Narcotic
/ therapeutic use
Analgesics, Opioid
/ therapeutic use
Complementary Therapies
Decision Support Systems, Clinical
Electronic Health Records
Exercise Therapy
Female
Humans
Linear Models
Male
Middle Aged
Multilevel Analysis
Pain
/ drug therapy
Pain Management
/ methods
Pain Measurement
Practice Guidelines as Topic
Primary Health Care
/ methods
Psychological Distress
Quality of Life
Chronic pain
Decision support
Federally Qualified Health Centers
Health information technology
Pain management
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
05
05
2021
revised:
06
07
2021
accepted:
07
07
2021
pubmed:
20
8
2021
medline:
29
1
2022
entrez:
19
8
2021
Statut:
ppublish
Résumé
Primary care providers manage most patients with chronic pain. Pain is a complex problem, particularly in underserved populations. A technology-enabled, point-of-care decision support tool may improve pain management outcomes. We created an electronic health record (EHR)-based decision support tool, the Pain Management Support System-Primary Care (PMSS-PC), and studied the tool-plus-education in 6 Federally Qualified Health Center practices using a randomized, wait-list controlled design. The PMSS-PC generated "best practice alerts," gave clinicians access to a pain assessment template, psychological distress and substance use measures, guidelines for drug and non-drug therapies, and facilitated referrals. Practices were randomly assigned to early vs delayed (after 6 months) implementation of the intervention, including technical support and 6 webinars. The primary outcome was change in worst pain intensity scores after 6 months, assessed on the Brief Pain Inventory-Short Form. Changes in outcomes were compared between the practices using linear multilevel modeling. The EHR provided clinician data on PMSS-PC utilization. The 256 patients in the early implementation practices had significantly improved worst pain (standardized effect size [ES] = -.32) compared with the 272 patients in the delayed implementation practices (ES = -.11). There was very low clinician uptake of the intervention in both conditions. Early implementation of the PMSS-PC improved worst pain, but this effect cannot be attributed to clinician use of the tool. Further PMSS-PC development is not indicated, but practice-level interventions can improve pain, and studies are needed to identify the determinants of change.
Sections du résumé
BACKGROUND
Primary care providers manage most patients with chronic pain. Pain is a complex problem, particularly in underserved populations. A technology-enabled, point-of-care decision support tool may improve pain management outcomes.
METHODS
We created an electronic health record (EHR)-based decision support tool, the Pain Management Support System-Primary Care (PMSS-PC), and studied the tool-plus-education in 6 Federally Qualified Health Center practices using a randomized, wait-list controlled design. The PMSS-PC generated "best practice alerts," gave clinicians access to a pain assessment template, psychological distress and substance use measures, guidelines for drug and non-drug therapies, and facilitated referrals. Practices were randomly assigned to early vs delayed (after 6 months) implementation of the intervention, including technical support and 6 webinars. The primary outcome was change in worst pain intensity scores after 6 months, assessed on the Brief Pain Inventory-Short Form. Changes in outcomes were compared between the practices using linear multilevel modeling. The EHR provided clinician data on PMSS-PC utilization.
RESULTS
The 256 patients in the early implementation practices had significantly improved worst pain (standardized effect size [ES] = -.32) compared with the 272 patients in the delayed implementation practices (ES = -.11). There was very low clinician uptake of the intervention in both conditions.
CONCLUSIONS
Early implementation of the PMSS-PC improved worst pain, but this effect cannot be attributed to clinician use of the tool. Further PMSS-PC development is not indicated, but practice-level interventions can improve pain, and studies are needed to identify the determinants of change.
Identifiants
pubmed: 34411523
pii: S0002-9343(21)00499-X
doi: 10.1016/j.amjmed.2021.07.014
pii:
doi:
Substances chimiques
Analgesics, Non-Narcotic
0
Analgesics, Opioid
0
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1546-1554Subventions
Organisme : NIMHD NIH HHS
ID : L60 MD009309
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.