Impact of an Electronic Pain and Opioid Risk Assessment Program: Are There Improvements in Patient Encounters and Clinic Notes?

• Published in: Pain medicine (Malden, Mass.) Vol. 17; no. 11; pp. 2047 - 2060
• Main Authors: Butler, Stephen F., Zacharoff, Kevin L., Charity, Sadaf, Black, Ryan A., Chung, Emma, Barreveld, Antje, Clark, Molly S., Jamison, Robert N.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2016
• Subjects: Adult; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Chronic pain; Electronic Health Records - standards; Electronic Health Records - trends; Female; Humans; Male; Middle Aged; Mood; Narcotics; Opioids; OPIOIDS, SUBSTANCE ABUSE & ADDICTIONS SECTION; Pain; Pain - diagnosis; Pain - drug therapy; Pain - psychology; Pain Measurement - standards; Pain Measurement - trends; Patient assessment; Patients; Program Evaluation - standards; Program Evaluation - trends; Risk Assessment; Self Report - standards; Substance use; Surveys and Questionnaires - standards; Measurement; Screening Tools; Risk Factors; Documentation; Opioids; Innovative Technology; Quality of Life; Electronic Assessment; Substance Abuse; Chronic Pain
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnw033

Objective. A comprehensive electronic self-report assessment, called PainCAS® (Clinical Assessment System), was developed and implemented in three clinics. PainCAS captures demographic information, pain assessment, quality-of-life variables, and contains validated, electronic versions of screeners for risk of aberrant opioid-related behaviors (the SOAPP and COMM). This investigation sought to determine the impact of PainCAS on documentation of pain and opioid risk evaluations. Exploratory hypotheses examined changes in the content of the patient-provider interaction and any impact on outcome. Methods. In study 1, chart reviews were conducted between pain patients who completed the electronic program (N = 89) and controls who represented standard of care (N = 120). In study 2, two groups of chronic pain patients (treatment-as-usual Control condition = 75, PainCAS Experimental condition = 72) were interviewed after completing their index clinic visit and completed mailed questionnaires 3 months later. Results. Results revealed significantly more key, pain-relevant chart elements documented in charts of patients who completed the PainCAS than those using a traditional paper questionnaire (Study 1; <0.001). In Study 2, the Experimental group reported more discussion about legal issues, substance use history, and medication safety compared with the Control group (p < 0.05). Satisfaction questionnaire responses supported provider and patient perceived benefit from using PainCAS. However, as expected, no differences were found between conditions on outcome measures of pain, mood, and function. Conclusions. Results indicate that use of the PainCAS electronic pain assessment improves documentation of chart elements in clinic notes and is associated with increased discussion of key, pain-relevant topics during the clinical visit.