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Randomized Controlled Trial
. 2020 May;61(5):640-644.
doi: 10.1002/mus.26774. Epub 2019 Dec 18.

Randomized controlled trial of a clinical decision support system for painful polyneuropathy

Evan L Reynolds  1 , James F Burke  1   2 , Mousumi Banerjee  3 , Brian C Callaghan  1   2
Affiliations
Randomized Controlled Trial

Randomized controlled trial of a clinical decision support system for painful polyneuropathy

Evan L Reynolds et al. Muscle Nerve. 2020 May.

Abstract

Introduction: Despite the existence of guidelines, painful neuropathy is often inappropriately treated. We sought to determine the effectiveness of a clinical decision support system on guideline-recommended medication use.

Methods: We randomized neurology providers, stratified by subspecialty, to a best practice alert (BPA) linked to a Smartset or a BPA alone when seeing patients with neuropathy. The primary outcome was the proportion of patients with uncontrolled nerve pain prescribed a guideline-recommended medication. Generalized estimating equations were used to assess effectiveness.

Results: Seventy-five neurology providers (intervention 38, control 37) treated 2697 patients with neuropathy (intervention 1026, control 671). Providers did not acknowledge the BPA in 1928 (71.5%) visits. Only four of eight intervention arm neurologists who treated patients with uncontrolled nerve pain opened the Smartset. The intervention was not associated with guideline-recommended medication use (odds ratio 0.52, 0.18-1.48; intervention 52%, control 54.8%).

Discussion: Our intervention did not improve prescribing practices for painful neuropathy. Physicians typically ignored the BPAs/Smartset; therefore, future studies should mandate their use or employ alternate strategies.

Keywords: best practice alert; clinical decision support systems; neuropathic pain; neuropathy; opioid; randomized controlled trial.

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Conflict of interest statement

CONFLICT OF INTEREST

Brian Callaghan receives research support from Impeto Medical Inc. He performs medical consultations for Advance Medical, consults for a PCORI grant, consults for the immune tolerance network, and performs medical legal consultations. James Burke has received compensation from Astra Zeneca for his role on the adjudication committee of the SOCRATES trial. Evan Reynolds and Mousumi Banerjee report no conflicts of interest related to this report.

Comment in

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