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

• Published in: International journal of medical informatics (Shannon, Ireland) Vol. 192; p. 105649
• Main Authors: Cuadros, Pablo, McCord, Emma, McDonnell, Cara, Apathy, Nate C., Sanner, Lindsey, Adams, Meredith C.B., Mamlin, Burke W., Vest, Joshua R., Hurley, Robert W., Harle, Christopher A., Mazurenko, Olena
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-12-2024
• Subjects: Chronic pain; Clinical decision support tool; Primary care; Use; Clinical decision support tool; Primary care; Use; Chronic pain
• ISSN: 1386-5056; 1872-8243; 1872-8243
• DOI: 10.1016/j.ijmedinf.2024.105649

•A CDS tool (OneSheet) for managing non-cancer chronic pain in primary care was introduced to 69 primary care physicians (PCPs) in 2 academic health centers.•The objective of this study was to Identify barriers, facilitators, and recommendations to increase OneSheet use for chronic noncancer pain management in primary care. A purposive sample of 19 PCPs were interviewed about their experience using OneSheet.•Barriers reported by PCPs included: Limited time to address patient needs associated with multiple chronic conditions, resistance to changing established workflows, complex information display.•PCPs reported the following facilitators to using Onesheet: its ability to serve as a hub for chronic pain related patient data, easy access to features that help complete mandatory tasks for chronic pain management, and improved planning for certain patient visits.•PCPs recommended prioritizing access to commonly used features, adding more display customization features, and expanding access to patients and other team members.
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.
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.
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.
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.