Randomized controlled trial of a clinical decision support system for painful polyneuropathy. Issue 5 (18th December 2019)

• Record Type: Journal Article
• Authors: Reynolds, Evan L.; Burke, James F.; Banerjee, Mousumi; Callaghan, Brian C.
• Is Part Of: Muscle & nerve. Volume 61:Issue 5(2020)
• Page Start: 640
• Page End: 644
• Publication Date: 2019-12-18
• Subjects: best practice alert -- clinical decision support systems -- neuropathic pain -- neuropathy -- opioid -- randomized controlled trial; Neuromuscular diseases -- Periodicals; Muscles -- Periodicals; Nerves -- Periodicals; 616.74
• DOI: 10.1002/mus.26774
• Languages: English
• ISSNs: 0148-639X

Abstract

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. Abstract : See editorial on pages 552–553 in this issue .