JMIR Publications

ABSTRACT

Background:

Chronic pain management in older adults can be challenging for primary care clinicians because of comorbidities, side effects, and complicated guideline recommendations. Clinical decision support systems (CDSS) can enhance guideline adherence in chronic pain management by collecting and organizing patient information and aiding clinician decision-making. This study examined clinicians’ views on challenges in managing chronic pain and their opinions on a CDSS that gathered patient preferences and provided clinicians with decision support for chronic pain management.

Objective:

The objective of this study was to explore primary care clinicians’ perspectives on the challenges of managing chronic pain in older adults and evaluate their opinions on a clinical decision support system (CDSS) designed to gather patient preferences and facilitate guideline-based, multimodal pain management.

Methods:

We conducted semi-structured interviews with 18 clinicians from two University of Chicago Medicine primary care clinics piloting the CDSS. The interview guide was informed by the Consolidated Framework for Implementation Research.

Results:

Participants included 89% physicians and 11% advanced practice nurses. Participants stressed the importance of a comprehensive, patient-centered approach to chronic pain management and favored multimodal and non-pharmacological treatments. Challenges included complex medical histories, competing priorities, insurance limitations, and opioid misuse concerns. Clinicians found the CDSS beneficial for promoting multimodal care discussions and enhancing visit efficiency. However, there were concerns regarding its complexity, workflow compatibility, and older patients' technology navigation difficulties. While tools, such as the pre-visit questionnaire and conversation tool, were valued, clinicians emphasized the need for adaptability and streamlined usability.

Conclusions:

The primary care clinicians in this study were aligned with clinical practice guidelines to provide patient-centered pain management using multimodal treatments. However, they had several concerns regarding how complex chronic pain management can be for older adult patients. They expressed interest in using the CDSS but were concerned about its complexity. I-COPE offers a promising approach to support guideline-based chronic pain and opioid management in primary care. By addressing usability and workflow compatibility, CDSS tools like I-COPE can better equip clinicians to provide comprehensive, patient-centered care, ultimately enhancing treatment outcomes for older adults with chronic pain.