JMIR Publications

ABSTRACT

Background:

Computerized decision support systems (CDSS) have emerged as an approach to improve compliance of clinicians with clinical practice guidelines (CPG). Research utilizing CDSS has primarily been conducted in clinical contexts with clear diagnostic criteria, such as diabetes and cardiovascular diseases. In contrast, research on CDSS for pain management, and more specifically neuropathic pain (NeP) has been limited. A CDSS for NeP has the potential to enhance patient care as the challenge of diagnosing and treating NEP often leads to tension in clinician-patient relationships

Objective:

To design and evaluate a clinical decision support system (CDSS) aimed at improving adherence of inter-professional primary care clinicians to clinical practice guidelines (CPG) for managing neuropathic pain (NeP).

Methods:

Recommendations from Canadian CPGs informed decision pathways. The development of CDSS format and function involved participation of multiple stakeholders and end-users in needs assessment and usability testing. Clinicians, including family medicine physicians, residents, and nurse practitioners, in 3 academic teaching clinics were trained in use of the CDSS. Evaluation over 1 year included measurement of utilization of the CDSS; change in reported awareness, agreement and adoption of CPG recommendations; and change in observed adherence to CPG recommendations.

Results:

Usability testing of the CDSS was highly successful in the prototype environment. Deployment in the clinical setting was partially complete by the time of the study, with some limitations in planned functionality. The study population had a high level of awareness, agreement and adoption of guideline recommendations prior to implementation of CDSS. Still, there was a small and statistically significant improvement in mean awareness and adoption scores over the year of observation (P=.01 for mean awareness scores at 6 and 12 months compared to baseline; P<0.01 for mean adoption scores at 6 months compared to baseline; P=.01 for mean adoption scores at 12 months). Documenting significant findings related to diagnosis of neuropathic pain increased significantly. Clinicians accessed CPG information more frequently than they utilized data entry functions. Nurse practitioners and first year family medicine trainees had higher utilization than physicians

Conclusions:

The CDSS was more helpful as a source of knowledge provision and as a training tool, than as dynamic decision support. The process of developing and deploying the CDSS was associated with observed increase in compliance with guideline recommendations.