JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Knab, J. H. Articles by Weinger, M. B. Search for Related Content PubMed PubMed Citation Articles by Knab, J. H. Articles by Weinger, M. B. Related Collections Pain Technology

---

PAIN MEDICINE

The Use of a Computer-Based Decision Support System Facilitates Primary Care Physicians’ Management of Chronic Pain

John H. Knab, MD^*, Mark S. Wallace, MD, R. Lee Wagner, MD^*, John Tsoukatos, PhD^||, and Matthew B. Weinger, MD

*Anesthesia Services Medical Group; Departments of Anesthesiology and Pain Medicine, University of California, San Diego; VA San Diego Healthcare System; and ||NovaTelligence, Inc., San Diego, California

Address correspondence and reprint requests to Matthew B. Weinger, MD, VA Medical Center (125), 3350 La Jolla Village Dr., San Diego, CA 92161–5085. Address e-mail to mweinger{at}ucsd.edu

We tested whether computer-based decision support (CBDS) could enhance the ability of primary care physicians (PCPs) to manage chronic pain. Structured summaries were generated for 50 chronic pain patients referred by PCPs to a pain clinic. A pain specialist used a decision support system to determine appropriate pain therapy and sent letters to the referring physicians outlining these recommendations. Separately, five board-certified PCPs used a CBDS system to "treat" the 50 cases. A successful outcome was defined as one in which new or adjusted therapies recommended by the software were acceptable to the PCPs (i.e., they would have prescribed it to the patient in actual practice). Two pain specialists reviewed the PCPs’ outcomes and assigned medical appropriateness scores (0 = totally inappropriate to 10 = totally appropriate). One year later, the hospital database provided information on how the actual patients’ pain was managed and the number of patients re-referred by their PCP to the pain clinic. On the basis of CBDS recommendations, the PCP subjects "prescribed" additional pain therapy in 213 of 250 evaluations (85%), with a medical appropriateness score of 5.5 ± 0.1. Only 25% of these chronic pain patients were subsequently re-referred to the pain clinic within 1 yr. The use of a CBDS system may improve the ability of PCPs to manage chronic pain and may also facilitate screening of consults to optimize specialist utilization.

IMPLICATIONS: The use of a computer-based decision support system may improve the ability of primary care physicians to manage chronic pain and may also facilitate screening of consults to optimize specialist utilization.

This article has been cited by other articles:

				D. B. Gordon, J. L. Dahl, C. Miaskowski, B. McCarberg, K. H. Todd, J. A. Paice, A. G. Lipman, M. Bookbinder, S. H. Sanders, D. C. Turk, et al. American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management: American Pain Society Quality of Care Task Force Arch Intern Med, July 25, 2005; 165(14): 1574 - 1580. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999