Pain Management in Primary Care: A Randomized Controlled Trial of a Computerized Decision Support Tool.

Abstract Background : Primary care providers manage most patients with chronic pain. Pain is a complex problem, particularly in underserved populations. A technology-enabled, point-of-care decision support tool may improve pain management outcomes. Methods : We created an electronic health record (EHR)-based decision support tool, the Pain Management Support System—Primary Care (PMSS-PC), and studied the tool-plus-education in in six Federally Qualified Health Center (FQHC) practices using a randomized, wait-list controlled design. The PMSS-PC generated “best practice alerts”, gave clinicians access to a pain assessment template, psychological distress and substance use measures, guidelines for drug and non-drug therapies, and facilitated referrals. Practices were randomly assigned to early versus delayed (after 6 months) implementation of the intervention, including technical support and six webinars. The primary outcome was change in worst pain intensity scores after six months, assessed on the Brief Pain Inventory-Short Form. Changes in outcomes were compared between the practices using linear multi-level modeling. The EHR provided clinician data on PMSS-PC utilization. Results : The 256 patients in the early implementation practices had significantly improved worst pain (standardized effect size [ES]=-.32) compared to the 272 patients in the delayed implementation practices (ES=-.11). There was very low clinician uptake of the intervention in both conditions. Conclusions : Early implementation of the PMSS-PC improved worst pain, but this effect cannot be attributed to clinician use of the tool. Further PMSS-PC development is not indicated, but practice-level interventions can improve pain and studies are needed to identify the determinants of change.