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Pain Management in Primary Care: A Randomized Controlled Trial of a Computerized Decision Support Tool
Lara Dhingra1, Robert Schiller2, Raymond Teets2
1MJHS Institute for Innovation in Palliative Care, New York, NY; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
The American Journal of Medicine
|August 19, 2021
Summary
A new electronic health record tool improved chronic pain management in primary care, but its effectiveness wasn't linked to clinician use. Further research is needed to understand how to best implement such tools for better patient outcomes.
Area of Science:
- Health Services Research
- Clinical Informatics
- Pain Management
Background:
- Primary care providers are central to managing chronic pain, a complex issue disproportionately affecting underserved populations.
- Effective pain management strategies are crucial for improving patient quality of life.
- Technology-driven solutions offer potential to enhance clinical decision-making at the point of care.
Purpose of the Study:
- To evaluate the impact of an electronic health record-based decision support tool, the Pain Management Support System-Primary Care (PMSS-PC), on chronic pain management outcomes.
- To assess the effectiveness of the tool when combined with educational interventions in Federally Qualified Health Centers.
- To determine the relationship between clinician utilization of the tool and patient pain reduction.
Main Methods:
- A randomized, wait-list controlled trial was conducted across 6 Federally Qualified Health Center practices.
- The study involved an electronic health record-integrated tool providing alerts, assessment templates, and guideline-based recommendations.
- Patients were assessed using the Brief Pain Inventory-Short Form, with outcomes compared between early and delayed implementation groups.
Main Results:
- Early implementation of the PMSS-PC demonstrated a significant improvement in worst pain intensity scores compared to delayed implementation.
- The standardized effect size for pain improvement was -.32 in the early group versus -.11 in the delayed group.
- Clinician uptake and utilization of the PMSS-PC tool were notably low across all participating practices.
Conclusions:
- The technology-enabled intervention showed a positive impact on worst pain, independent of direct clinician engagement with the tool.
- Further development of the specific PMSS-PC tool is not recommended.
- Practice-level interventions hold promise for improving pain management, necessitating further research into the determinants of successful implementation and change.
