Browsing by Author "Hurley, Robert W."

Now showing 1 - 7 of 7
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    An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy
    (SAGE Publications, 2019-12-10) Danielson, Elizabeth C.; Mazurenko, Olena; Andraka-Christou, Barbara T.; DiIulio, Julie; Downs, Sarah M.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public Health
    Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis (n = 10), spondylosis (n = 6), and low back pain (n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.
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    Assessing the use of a clinical decision support tool for pain management in primary care
    (Oxford University Press, 2022-09-15) Apathy, Nate C.; Sanner, Lindsey; Adams, Meredith C.B.; Mamlin, Burke W.; Grout, Randall W.; Fortin, Saura; Hillstrom, Jennifer; Saha, Amit; Teal, Evgenia; Vest, Joshua R.; Menachemi, Nir; Hurley, Robert W.; Harle, Christopher A.; Mazurenko, Olena; Health Policy and Management, School of Public Health
    Objective: Given time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial. Materials and methods: The tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals. Results: Overall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9-32]; site 2: median: 8 [IQR 5-16]). Seven "power users" accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites. Discussion: Modest OneSheet use was observed relative to the number of eligible patients seen with chronic pain. Conclusions: Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows.
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    The Effect of EHR-Integrated Patient Reported Outcomes on Satisfaction with Chronic Pain Care
    (2016-12-01) Harle, Christopher A.; Marlow, Nicole M.; Schmidt, Siegfried O. F.; Shuster, Jonathan J.; Listhaus, Alyson; Fillingim, Roger B.; Hurley, Robert W.; Department of Health Policy and Management, School of Public Health
    Objective Given its complexity, chronic noncancer pain presents an opportunity to use health information technology (IT) to improve care experiences. The objective of this study was to assess whether integrating patient-reported outcomes (PRO) data in an electronic health record (EHR) affects providers and patient satisfaction with chronic noncancer pain care. Study Design We conducted a pragmatic cluster randomized trial involving four family medicine clinics. Methods We enrolled primary care providers (PCPs) and their patients with chronic noncancer pain. In the first seven months (education phase), PCPs in intervention practices received education on how to use PROs for pain care. In the second seven months (PRO phase), patients in intervention practices reported pain-related outcomes upon arrival at their visits. PROs were immediately reported to PCPs through the EHR. Control group PCPs provided usual care. We compared intervention and control practices in terms of provider and patient satisfaction with care. Results During the education phase, patients’ mean ratings of their visits did not differ between control and intervention (9.33 vs. 9.08, p=0.20). During the PRO phase, patients’ mean ratings did not differ between control and intervention (9.28 vs 9.01, p=0.20). Similarly, there were no differences between the intervention and control groups in terms of provider satisfaction. Conclusion Delivering EHR-integrated PROs did not consistently improve patient or provider satisfaction. Positively, we found no evidence that the PRO tools negatively affected satisfaction. Future studies and technological innovations are needed to translate point-of-care health IT tools to improvements in patient and provider experiences.
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    Evaluation of electronic recruitment efforts of primary care providers as research subjects during the COVID-19 pandemic
    (BMC, 2022-04-28) Mazurenko, Olena; Sanner, Lindsey; Apathy, Nate C.; Mamlin, Burke W.; Menachemi, Nir; Adams, Meredith C.B.; Hurley, Robert W.; Fortin Erazo, Saura; Harle, Christopher A.; Medicine, School of Medicine
    Background: Recruiting healthcare providers as research subjects often rely on in-person recruitment strategies. Little is known about recruiting provider participants via electronic recruitment methods. In this study, conducted during the COVID-19 pandemic, we describe and evaluate a primarily electronic approach to recruiting primary care providers (PCPs) as subjects in a pragmatic randomized controlled trial (RCT) of a decision support intervention. Methods: We adapted an existing framework for healthcare provider research recruitment, employing an electronic consent form and a mix of brief synchronous video presentations, email, and phone calls to recruit PCPs into the RCT. To evaluate the success of each electronic strategy, we estimated the number of consented PCPs associated with each strategy, the number of days to recruit each PCP and recruitment costs. Results: We recruited 45 of 63 eligible PCPs practicing at ten primary care clinic locations over 55 days. On average, it took 17 business days to recruit a PCP (range 0-48) and required three attempts (range 1-7). Email communication from the clinic leaders led to the most successful recruitments, followed by brief synchronous video presentations at regularly scheduled clinic meetings. We spent approximately $89 per recruited PCP. We faced challenges of low email responsiveness and limited opportunities to forge relationships. Conclusion: PCPs can be efficiently recruited at low costs as research subjects using primarily electronic communications, even during a time of high workload and stress. Electronic peer leader outreach and synchronous video presentations may be particularly useful recruitment strategies.
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    Examining primary care provider experiences with using a clinical decision support tool for pain management
    (Oxford University Press, 2023-08-09) Mazurenko, Olena; McCord, Emma; McDonnell, Cara; Apathy, Nate C.; Sanner, Lindsey; Adams, Meredith C. B.; Mamlin, Burke W.; Vest, Joshua R.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public Health
    Objective: To evaluate primary care provider (PCP) experiences using a clinical decision support (CDS) tool over 16 months following a user-centered design process and implementation. Materials and methods: We conducted a qualitative evaluation of the Chronic Pain OneSheet (OneSheet), a chronic pain CDS tool. OneSheet provides pain- and opioid-related risks, benefits, and treatment information for patients with chronic pain to PCPs. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems. Results: PCPs stated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs used OneSheet for distinct subgroups of patients with chronic pain, including patients prescribed opioids, with poorly controlled pain, or new to a provider or clinic. PCPs reported variable workflow integration and selective use of certain OneSheet features driven by their preferences and patient population. PCPs recommended broadening OneSheet access to clinical staff and patients for data entry to address clinician time constraints. Discussion: Differences in patient subpopulations and workflow preferences had an outsized effect on CDS tool use even when the CDS contained the right information identified in a user-centered design process. Conclusions: To increase adoption and use, CDS design and implementation processes may benefit from increased tailoring that accommodates variation and dynamics among patients, visits, and providers.
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    Information Needs and Requirements for Decision Support in Primary Care: An Analysis of Chronic Pain Care
    (AMIA, 2018) Harle, Christopher A.; Apathy, Nate C.; Cook, Robert L.; Danielson, Elizabeth C.; DiIulio, Julie; Downs, Sarah M.; Hurley, Robert W.; Mamlin, Burke W.; Militello, Laura G.; Anders, Shilo; Health Policy and Management, School of Public Health
    Decision support system designs often do not align with the information environments in which clinicians work. These work environments may increase Clinicians’ cognitive workload and harm their decision making. The objective of this study was to identify information needs and decision support requirements for assessing, diagnosing, and treating chronic noncancer pain in primary care. We conducted a qualitative study involving 30 interviews with 10 primary care clinicians and a subsequent multidisciplinary systems design workshop. Our analysis identified four key decision requirements, eight clinical information needs, and four decision support design seeds. Our findings indicate that clinicians caring for chronic pain need decision support that aggregates many disparate information elements and helps them navigate and contextualize that information. By attending to the needs identified in this study, decision support designers may improve Clinicians’ efficiency, reduce mental workload, and positively affect patient care quality and outcomes.
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    Understanding how primary care clinicians make sense of chronic pain
    (Springer, 2018-11) Militello, Laura G.; Anders, Shilo; Downs, Sarah M.; Diiulio, Julie; Danielson, Elizabeth C.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public Health
    Chronic pain leads to reduced quality of life for patients, and strains health systems worldwide. In the US and some other countries, the complexities of caring for chronic pain are exacerbated by individual and public health risks associated with commonly used opioid analgesics. To help understand and improve pain care, this article uses the data frame theory of sensemaking to explore how primary care clinicians in the US manage their patients with chronic noncancer pain. We conducted Critical Decision Method interviews with ten primary care clinicians about 30 individual patients with chronic pain. In these interviews, we identified several patients, social/environmental, and clinician factors that influence the frames clinicians use to assess their patients and determine a pain management plan. Findings suggest significant ambiguity and uncertainty in clinical pain management decision making. Therefore, interventions to improve pain care might focus on supporting sensemaking in the context of clinical evidence rather than attempting to provide clinicians with decontextualized and/or algorithm-based decision rules. Interventions might focus on delivering convenient and easily interpreted patient and social/environmental information in the context of clinical practice guidelines.