Chronic Pain
Conditions
Brief summary
Chronic pain is highly prevalent, compromises quality of life, and increases care utilization. Primary care providers are challenged to provide effective treatments, use opioid therapy appropriately, and address the adverse consequences of pain. Technology-enabled decision support tools may provide a means to improve pain management in primary care. The objective of this study was to evaluate a novel electronic health record (EHR)-based decision support tool-plus-education intervention for pain management in primary care.
Detailed description
This randomized, wait-list controlled trial evaluated a novel EHR-based system for pain management among patients with chronic pain in six practices of a Federally Qualified Health Center network in New York.
Interventions
OTHEREarly intervention
The Pain Management Support System for Primary Care (PMSS-PC) generated best practice alerts and gave clinicians access to a pain assessment template, measures of psychological distress and substance use, guidelines for drug and non-drug therapies, and facilitated referrals. At implementation, clinicians at the practices were offered in-person and virtual education through six webinars on best practices for pain.
OTHERDelayed intervention
Delayed wait-list control group. The second arm involved three additional sites receiving the PMSS-PC intervention 6 months after the first arm. Initial outcomes from the PMSS-PC Experimental Intervention arm were compared to those of this Wait-list Control arm.
Sponsors
Pfizer
The Institute for Family Health
MJHS Institute for Innovation in Palliative Care
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Treated at the Institute for Family Health 2. Spoke English or Spanish 3. Received one or more prescriptions for an opioid or nonopioid analgesic during the past three months 4. Pain screening at the prior three office visits documented scores \>3 on the 0-6 scale (FACES, Hicks et al., 2001). 5. Willingness to complete questionnaires three times 6. A commitment to return to the practice 7. Reachable by phone 8. No evidence of psychopathology or cognitive impairment severe enough to prevent informed consent or completing the survey instruments
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Worst Pain Intensity | From baseline to 6 months following intervention implementation | Worst pain intensity score on the Brief Pain Inventory-Short Form. Scores range from 0-10, with higher scores indicating more severe worst pain intensity. |
| Average Pain Intensity | From baseline to 6 months following intervention implementation | Average pain intensity score on the Brief Pain Inventory-Short Form. Scores range from 0-10, with higher scores indicating more severe average pain intensity. |
| Pain Interference with Function | From baseline to 6 months following intervention implementation | Pain interference T-score, measured on the PROMIS Pain Interference Short Form. Higher scores indicate more pain interference with function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Worst Pain Intensity | From 6 to 12 months following intervention implementation | Worst pain intensity score on the Brief Pain Inventory-Short Form. Scores range from 0-10, with higher scores indicating more severe worst pain intensity. |
| Average Pain Intensity | From 6 to 12 months following intervention implementation | Average pain intensity score on the Brief Pain Inventory-Short Form. Scores range from 0-10, with higher scores indicating more severe average pain intensity. |
| Pain Interference with Function | From 6 to 12 months following intervention implementation | Pain interference T-score, measured on the PROMIS Pain Interference Short Form. Higher scores indicate more pain interference with function. |
| Uptake of the PMSS-PC intervention tool | From baseline to 12 months following intervention implementation | Use of the PMSS-PC decision support tool by primary care providers |
Outcome results
None listed