Examining primary care provider experiences with using a clinical decision support tool for pain management

Lay Summary We evaluated primary care providers' (PCP) experiences with a clinical decision support (CDS) tool called the Chronic Pain OneSheet (OneSheet), designed to assist with the management of patients with chronic pain. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems. PCPs indicated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs reported using OneSheet for specific patient subgroups, such as those prescribed opioids, with poorly controlled pain or new to a provider or clinic. However, OneSheet utilization varied depending on PCPs' workflow preferences and patient population. To address PCPs' time constraints, they recommended expanding OneSheet access to clinical staff and patients for data entry. Our findings highlight the importance of tailoring CDS tools to accommodate differences in patient characteristics, visits, and PCPs' workflow preferences. In conclusion, this study suggests that personalized CDS tools like OneSheet can enhance chronic pain management in primary care settings. By incorporating individualized elements and considering variations among patients, visits, and providers, these tools can better support PCPs in making informed decisions for effective chronic pain management. Objective To evaluate primary care provider (PCP) experiences using a clinical decision support (CDS) tool over 16 months following a user-centered design process and implementation. Materials and Methods We conducted a qualitative evaluation of the Chronic Pain OneSheet (OneSheet), a chronic pain CDS tool. OneSheet provides pain- and opioid-related risks, benefits, and treatment information for patients with chronic pain to PCPs. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems. Results PCPs stated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs used OneSheet for distinct subgroups of patients with chronic pain, including patients prescribed opioids, with poorly controlled pain, or new to a provider or clinic. PCPs reported variable workflow integration and selective use of certain OneSheet features driven by their preferences and patient population. PCPs recommended broadening OneSheet access to clinical staff and patients for data entry to address clinician time constraints. Discussion Differences in patient subpopulations and workflow preferences had an outsized effect on CDS tool use even when the CDS contained the right information identified in a user-centered design process. Conclusions To increase adoption and use, CDS design and implementation processes may benefit from increased tailoring that accommodates variation and dynamics among patients, visits, and providers.