The use of a computer-based decision support system facilitates primary care physicians' management of chronic pain

We tested whether computer-based decision support (CBDS) could enhance the ability of primary care physicians (PCPs) to manage chronic pain. Structured summaries were generated for 50 chronic pain patients referred by PCPs to a pain clinic. A pain specialist used a decision support system to determine appropriate pain therapy and sent letters to the referring physicians outlining these recommendations. Separately, five board-certified PCPs used a CBDS system to "treat" the 50 cases. A successful outcome was defined as one in which new or adjusted therapies recommended by the software were acceptable to the PCPs (i.e., they would have prescribed it to the patient in actual practice). Two pain specialists reviewed the PCPs' outcomes and assigned medical appropriateness scores (0 = totally inappropriate to 10 = totally appropriate). One year later, the hospital database provided information on how the actual patients' pain was managed and the number of patients re-referred by their PCP to the pain clinic. On the basis of CBDS recommendations, the PCP subjects "prescribed" additional pain therapy in 213 of 250 evaluations (85%), with a medical appropriateness score of 5.5 +/- 0.1. Only 25% of these chronic pain patients were subsequently re-referred to the pain clinic within 1 yr. The use of a CBDS system may improve the ability of PCPs to manage chronic pain and may also facilitate screening of consults to optimize specialist utilization.