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

J Am Med Inform Assoc. 2020 Apr 1;27(4):613-620. doi: 10.1093/jamia/ocz213.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Decision Support Systems, Clinical*
  • Drug Prescriptions / statistics & numerical data
  • Electronic Health Records*
  • Humans
  • Internship and Residency
  • Medical Order Entry Systems
  • Pain Management
  • Practice Patterns, Physicians'*
  • Prescription Drug Monitoring Programs*
  • Systems Integration*
  • United States
  • User-Computer Interface*

Substances

  • Analgesics, Opioid