As the opioid crisis continues to ravage American communities, our researchers continue to look for solutions and interventions that can empower those communities to recognize and treat Opioid Use Disorder (OUD).
A new, groundbreaking approach to fight the crisis involves Patient-Centered Clinical Decision Support (PCCDS) that uses a variety of applications along with electronic health records to guide clinicians in screening and treating patients dealing with OUD.
Clinical Decision Support (CDS) uses a variety of computer-based tools that provide clinicians, staff and patients with knowledge and patient-specific information, intelligently filtered or presented at appropriate times, to enhance decision-making in the context of clinical care.
Patient-Centered Clinical Decision Support (PCCDS) is CDS that directly involves or addresses patients to encourage patient activation, education, engagement, and shared decision-making between patients and their care teams.
In 2018, the PCCDS Learning Network focused its efforts on developing an Opioid Action Plan (OAP) titled, “Stakeholder-driven Action Plan for Improving Pain Management, Opioid Use, and Opioid Use Disorder Treatment Through Patient-Centered Clinical Decision Support” to articulate and begin making progress toward applying PCCDS to address OUD.
The results of the working group’s efforts are a set of recommended actions that stakeholders can employ to improve care delivery and reduce inappropriate opioid use and abuse. The action plan, released on March 28, outlines 19 PCCDS tools and five detailed patient scenarios that explore the ways in which PCCDS can support better care delivery and outcomes to prevent or intervene with OUD. The report also proposed 11 areas of recommended actions ranging from fostering best practices and collaboration among association members to leveraging available funding to support providers in procuring and implementing PCCDS tools and workflows. The report also documented four areas where implementation efforts are already underway. (Read the full report.)
The OAP Working Group was initially comprised of 15 people from an array of public and private stakeholder groups and organizations, including patient advocates, care delivery organizations, opioid guideline developers and others. As they worked, the group grew into a team of over 50 people.
Future Scenarios: Putting PCCDS in Action to Prevent OUD
In total, the working group compiled 19 PCCDS computer-based tools, all of which are illustrated within five “Future Scenarios.” The tools could benefit clinicians who are considering treating, or already managing, patients with opioids. The recommended tools include topic-specific, evidence-based information about medical conditions, a pre-visit questionnaire, an OUD assessment tool, online patient portals and a decision tool for helping patients and providers decide if opioid medications are the right option for them.
The Future Scenarios provide context as to how PCCDS could be used to manage opioid-related care. The scenarios include:
- A woman suffering from chronic knee pain due to osteoarthritis
- A man with acute kidney pain due to renal colic
- A man on long-term opioid therapy
- A woman dealing with post-surgical pain
- A man with OUD from multiple opioid prescriptions
In the first Future Scenario, for example, an “opioid-naïve” 65-year-old female with chronic knee pain uses the patient portal and is prompted to use a tracking journal to document the quality, duration and intensity of her knee pain.
Once she attends her medical appointment, her clinician and assistant view her pain log in the shared-decision making tool. They also look to see if she has received pain medications from other clinicians and view the results from a visit to an orthopedic doctor who did not recommend surgery. Using the shared decision-making tool, the patient and clinician discuss the risks, benefits and costs of different pain management approaches while factoring in the patient’s values and expectations. The clinician and patient come to an agreement that a non-opioid topical medication is the best approach.
The other four Future Scenarios also reference the 19 tools that could improve opioid-related care.
Taking Action: Implementing Recommendations
The group made numerous recommended actions to 11 specific stakeholders. Of the recommended actions developed from this process, one significant measure would be to leverage state Medicaid agency Chief Medical Officer connections to create measurement efforts to track progress and support further infrastructure development. Actions in accordance with the recommendations are already underway in four key areas.
Multiple agencies and vendors have already begun working to develop PCCDS and to explore the future scenarios. They are also working to drive adoption and successful use of available tools, foster research and promote ongoing collaboration.
The entire list of recommendations can be viewed in the report.
In total, this report offers a shared vision for how PCCDS tools can address pain management and opioid use by improving communication and decision-making for patients and their care teams.
The opioid crisis is a debilitating and deadly epidemic that hurts people regardless of gender, race, and class. The OAP demonstrates how researchers, vendors, patients, and providers from across the health care industry can come together to produce solutions, share what they’ve learned, and develop partnerships—even among competitors—to improve decision-making and manage care to fight the opioid crisis using new technologies and strategies.
