Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

Tennessee\u27s Annual Overdose Report 2019, Understanding and Responding to the Opioid

https://digitalcommons.memphis.edu/govpubs-tn-dept-health-drug-poisonings-in-tennessee/1017/thumbnail.jp

Policy Analysis: Appropriate Opioid Prescribing Practices for Post-Surgical Patients

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from Bardachs eightfold path to more effective problem solving (2000) guided the assembly and comparison of three evidence-based policies to reduce adverse effects of overprescribing practices with opioids. Three policy options assessed prescribing guidelines, patient risk assessment tools, and multimodal analgesia therapy with the intent to implement one or more. Keywords: dependence, opioids, policy analysis, post-surgical patients, opioid prescribing guidelines, risk assessment, pain management

A Comparison of Prescriber-Based Opioid Addiction Prevention Strategies: An Integrative Literature Review

Background: Opioid addiction causes many preventable deaths across the United States. Many recommendations to prevent opioid addiction have been made, however, many recommendations have not been fully evaluated for efficacy. This has led to a gap in knowledge for providers and healthcare systems to make informed decisions on how to reduce opioid addiction. Objectives: This study explores different prescriber-based opioid prevention strategies, providing an analysis and ranking for the strategies that most effectively reduce opioid abuse and exposure. Additionally, the analysis provides recommendations for future research. Methods: An integrative literature review was conducted to investigate three opioid abuse prevention strategies: prescription drug monitoring programs, physician continuing education, and risk assessment screening tools. Information has been organized according to prevention strategy type and presented in a data matrix table. Results: Most studies (4 out of 5) that examined risk assessment screening tool concluded that their use resulted in statistically significant reductions in opioid abuse. Prescription drug monitoring programs had more mixed results but overall resulted in modest reductions. Physician continuing education resulted in very few statistically significant outcomes. Discussion: The opioid abuse prevention strategies have the greatest to the least impact in the following order 1) risk assessment screening tools 2) prescription drug monitoring programs, and 3) prescriber continuing education. Keywords: Opioids, opioid abuse prevention, opioid addiction prevention, prescription drug monitoring programs, physician continuing education, risk assessment screening tool, risk assessment questionnaire, opioid abuse prevention strategie

System-level policies on appropriate opioid use, a multi-stakeholder consensus

Background:  This consensus statement was developed because there are concerns about the appropriate use of opioids for acute pain management, with opposing views in the literature. Consensus statement on policies for system-level interventions may help inform organisations such as management structures, government agencies and funding bodies. Methods:  We conducted a multi-stakeholder survey using a modified Delphi methodology focusing on policies, at the system level, rather than at the prescriber or patient level. We aimed to provide consensus statements for current developments and priorities for future developments. Results:  Twenty-five experts from a variety of fields with experience in acute pain management were invited to join a review panel, of whom 23 completed a modified Delphi survey of policies designed to improve the safety and quality of opioids prescribing for acute pain in the secondary care setting. Strong agreement, defined as consistent among> 75% of panellists, was observed for ten statements. Conclusions:  Using a modified Delphi study, we found agreement among a multidisciplinary panel, including patient representation, on prioritisation of policies for system-level interventions, to improve governance, pain management, patient/consumers care, safety and engagement.Publisher PDFPeer reviewe

Tennessee\u27s Annual Overdose Report 2021, Report on Epidemiologic Data, Efforts, and Collaborations to Address the Overdose Epidemic

https://digitalcommons.memphis.edu/govpubs-tn-dept-health-drug-poisonings-in-tennessee/1019/thumbnail.jp