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Randomized Controlled Trial
. 2020 Apr 1;27(4):613-620.
doi: 10.1093/jamia/ocz213.

How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

Mustafa I Hussain  1 , Ariana M Nelson  2 , Brent G Yeung  2 , Lauren Sukumar  3 , Kai Zheng  1
Affiliations
Randomized Controlled Trial

How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

Mustafa I Hussain et al. J Am Med Inform Assoc. .

Abstract

Objective: The United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.

Materials and methods: Twenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.

Results: Participants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.

Conclusions: How patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior.

Keywords: clinical; decision support systems; medical order entry systems; pain management; prescription drug monitoring programs; user-computer interface.

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Figures

Figure 1.
Figure 1.
Conventional design, which presents the patient’s medication history as a simple list (top), the prescription drug monitoring program information in a tabular format on a separate tab (middle), and interruptive modal dialogs for delivering decision support (bottom).
Figure 2.
Figure 2.
Alternative design, featuring a contextual cue when prescription drug monitoring program information is available (①), a graphical presentation of opioid prescription history (②), and noninterruptive decision support delivered as contextual cues as part of the ordering process (③, ④, and ⑤).
Figure 3.
Figure 3.
Appropriateness scores by specialty and experimental condition. PM&R: physical medicine and rehabilitation.
See this image and copyright information in PMC

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