Would Physicians Find a Clinical Decision Support System Helpful for Identifying/Managing Opioid Use Disorder?

Addiction Science Made Easy
December 2021
CTN Dissemination Library

Opioid use disorder (OUD) has become the leading cause of accidental death in the United States, and deaths from overdose are on the rise. Yet despite the fact there are several effective medications and therapies that can help, many people with OUD do not receive treatment.

Because primary care physicians most commonly provide opioid prescriptions, primary care is a logical and feasible place to identify patients at risk for OUD and refer or initiate treatment for it. However, time constraints, competing priorities, concerns about unpleasant reactions from patients, and lack of expertise have all been identified as major barriers.

A Clinical Decision Support (CDS) system integrated into the electronic health record seems like the perfect way to help address these issues. But would providers actually use a system like that?

For this study, researchers interviewed 8 primary care physicians participating in a pilot CDS study (CTN-0095: COMPUTE 2.0) to find out how they felt about talking about OUD with patients and what kind of support they thought they needed. 

After analyzing the transcripts from the interviews, five themes were identified:

1. Primary care is the right place to address OUD.
2. Both clinician-patient and clinician-clinician relationships can affect how and whether clinicians address OUD in a particular patient encounter. For example, physicians said they would be more likely to bring up OUD with a patient they already had a good relationship with and less likely to bring it up with a patient who is new to them or usually sees another provider. 
3. The main challenges reported were limited time and competing priorities for patients with complex needs.
4. Although a CDS for OUD could be very helpful, it must meet different needs for different clinicians and clinical situations and be simple to use.
5. For the best benefit, the CDS needs to be part of a bigger change in supportive organizational policies and systems and include local clinician encouragement and incentives. 

Conclusions: With the right design and a supportive organization, primary care physicians thought a CDS could help them better identify and address OUD in their patients. This information can help inform the development of better and more useful systems that can benefit both provider and patient.