Article Figures & Data
Figures
- Figure 1.
PRISMA Flow Diagram.
Tables
- Table 1.
Study Setting, Participants, Clinical Decision Support System (CDSS) Type, and Inclusion of Evidence-Based Components
Characteristic Local CDSS* N (%) PDMP CDSS** N (%) Country United States 6/6 (100%) 8/8 (100%) Practice settings Primary care clinic
Emergency department5/6 (83%)
1/6 (17%)6/8 (75%)
2/8 (25%)Types of PCPs Physicians
NPs6/6 (100%)
6/6 (100%)7/8 (88%)
4/8 (50%)CDSS type Dashboard
Protocol
Alert
Clinical tool
Data repository2/6 (33%)
2/6 (33%)
1/6 (17%)
1/6 (17%)
0/6 (0%)0/8 (0%)
0/8 (0%)
0/8 (0%)
0/8 (0%)
8/8 (100%)Evidence-based CDSS components° Integrated into EMR
Automatically activates
Requires a reason for over-ride
Provides advice to patients and providers3/6 (50%)
2/6 (33%)
0/6 (0%)
0/6 (0%)0/5 (0%)***
0/5 (0%)***
0/5 (0%)***
0/5 (0%)***Abbreviations: CDSS, clinical decision support system; EMR, electronic medical record; N/A, Not applicable; NP, nurse practitioner; PDMP, prescription drug monitoring program; PCPs, primary care providers.
↵* Local CDSSs are used locally within a specific health center, health system or clinic.
↵** PDMP CDSSs are large, centralized, government-run databases.
↵*** We excluded 3 studies because they included multiple PDMP CDSSs, and did not provide information on a specific CDSS.45,47,49
Note: Unless a study stated a component was included (e.g. automatic activation), we assumed it was not.
Aims Design Local CDSS* N (%) PDMP CDSS** N (%) To determine if a multi-faceted intervention improved prescribing/guideline adherence Cluster RCT***
Pre-post1/6 (17%)
4/6 (33%)0/8 (0%)
0/8 (0%)To determine whether a CDSS improved prescribing/guideline adherence Pre-post 0/6 (0%) 1/8 (13%) To determine if PCPs used a CDSS Retrospective cohort
Cross-sectional survey0/6 (0%)
0/6 (0%)1/8 (13%)
1/8 (13%)To determine if an intervention affected provider knowledge, behavior, attitudes and/or use related to CDSS Mixed-methods
Pre-post0/6 (0%)
0/6 (0%)1/8 (13%)
2/8 (25%)To learn about factors affecting opioid prescribing for CNCP, including use of CDSS Qualitative 0/6 (0%) 2/8 (25%) To pilot a multi-component intervention, including a CDSS Mixed-methods 1/6 (17%) 0/8 (0%) Abbreviations: CDSS, clinical decision support system; CNCP, chronic non-cancer pain; N/A, not applicable; PDMP, prescription drug monitoring program; RCT, randomized controlled trial; PCPs, primary care providers.
↵* Local CDSSs are used locally within a specific health center, health system or clinic.
↵** PDMP CDSSs are large, centralized, government-run databases.
↵*** CDSS included in both study arms.
Local CDSS* N (%) PDMP CDSS** N (%) Funding for CDSS development Public/Non-profit
Industry
Not sponsored
Unclear or not reported3/6 (50%)
0/6 (0%)
0/6 (0%)
3/6 (50%)0/8 (0%)
0/8 (0%)
0/8 (0%)
8/8 (100%)Funding for evaluation Public/non-profit
Industry
Not sponsored
Unclear or not reported4/6 (67%)
0/6 (0%)
0/6 (0%)
2/6 (33%)5/8 (63%)
0/8 (0%)
2/8 (25%)
1/8 (13%)Relationship between developers and evaluators Same person, group, or organization
Different person, group, or organization
Unclear or not reported4/6 (67%)
0/6 (0%)
2/6 (33%)0/8 (0%)
0/8 (0%)
8/8 (100%)# Searches 1 narcotics/ or analgesics, opioid/ or alfentanil/ or alphaprodine/ or buprenorphine/ or buprenorphine, naloxone drug combination/ or butorphanol/ or codeine/ or dextromoramide/ or dextropropoxyphene/ or dihydromorphine/ or diphenoxylate/ or “enkephalin, ala2-mephe4-gly5-"/ or “enkephalin, d-penicillamine2,5-"/ or ethylketocyclazocine/ or ethylmorphine/ or etorphine/ or fentanyl/ or heroin/ or hydrocodone/ or hydromorphone/ or levorphanol/ or meperidine/ or meptazinol/ or methadone/ or methadyl acetate/ or morphine/ or nalbuphine/ or opiate alkaloids/ or oxycodone/ or oxymorphone/ or pentazocine/ or phenazocine/ or phenoperidine/ or pirinitramide/ or promedol/ or sufentanil/ or tilidine/ or tramadol/ 2 (analgesic* or opioid* or opiate* or narcotic* or alfentanil or alphaprodine or buprenorphine or (buprenorphine adj2 naloxone) or suboxone or subutex or butorphanol or codeine or dihydrocodeine or dextromoramide or dextropropoxyphene or dihydromorphine or diphenoxylate or ethylketocyclazocine or ethylmorphine or etorphine or fentanyl or duragesic or hydrocodone or hydromorphone or levorphanol or meperidine or meptazinol or methadone or methadyl acetate or morphine or nalbuphine or oxycodone or oxymorphone or pentazocine or phenazocine or phenoperidine or pirinitramide or promedol or sufentanil or tilidine or tramadol or dilaudid or OPANA or targin or tapendatol or nalbuphine or trama*).kf,tw. 3 1 or 2 4 hospital information systems/ or ambulatory care information systems/ or medical order entry systems/ or point-of-care systems/ 5 Prescription Drug Monitoring Programs/ 6 medical informatics/ or health information exchange/ or medical informatics applications/ or decision making, computer-assisted/ or diagnosis, computer-assisted/ or therapy, computer-assisted/ or drug therapy, computer-assisted/ or decision support techniques/ or “information storage and retrieval"/ or data mining/ or health information interoperability/ or information systems/ or community networks/ or decision support systems, clinical/ or health information systems/ or integrated advanced information management systems/ or management information systems/ or clinical pharmacy information systems/ or database management systems/ or decision support systems, management/ or medical order entry systems/ or reminder systems/ or medical informatics computing/ or nursing informatics/ 7 microcomputers/ or computers, handheld/or smartphone/ 8 prescription drug misuse/or prescription drug overuse/ 9 "Drug and Narcotic Control"/mt, og, pc, sn, td [Methods, Organization & Administration, Prevention & Control, Statistics & Numerical Data, Trends] 10 Drug Monitoring/mt, sn [Methods, Statistics & Numerical Data] 11 4 or 5 or 6 or 7 or 8 or 9 or 10 12 ((health* or clinical or medic*) adj3 informatic*).kw, tw. 13 ((electronic* or computer*) adj3 order entr*).kw, tw. 14 ((phone* or cellphone* or smartphone* or handheld) adj4 (app$1 or application*)).kw, tw. 15 ((decision* or reminder* or point of care or point-of-care or alert*) adj3 (tool* or system* or electronic* or computer-assisted)).kw, tw. 16 (PDMP or PDMPs).kw, tw. 17 (PMP or PMPs).kw, tw. 18 ((prescri* or drug* or narcotic*) adj3 monitor*).tw, kw. 19 12 or 13 or 14 or 15 or 16 or 17 or 18 20 11 or 19 21 3 and 20 Database(s): Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE® 1946-Present Search Strategy.
Date Database URL Search Strategy No. Items Retrieved* No. Screened (Uploaded to Citation Manager) January 14, 2020 ClinicalTrials.gov ClinicalTrials.gov (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring database OR decision support) AND opioids 119 15 January 14, 2020 WHO ICTRP https://www.who.int/ictrp/en/ Opioid AND decision support
Opioid AND electronic
Opioid AND informatics
Opioid AND reminder
Opioid AND prescription drug monitoring program
Opioid AND alert
Opioid AND application
Opioid AND tool
Opioid AND phoneOpioid AND handheld7
14
0
0
1
1
5
6
29
72
1
0
0
0
0
0
0
0
1Databases Gray Literature
Date Organization URL Search Mechanism Search Strategy No. Items Retrieved No. Screened (uploaded to Citation Manager) January 14, 2020 Open Gray or Open Sigle www.opengrey.eu Site search (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring database OR decision support) AND opioidOpioid AND “decision support” 13 0 January 14, 2020 Gray literature Report https://www.greylit.org/(no longer updated as of January 2017) Site search Opioid 42 0 January 14, 2020 Department of Veterans Affairs www.va.gov Site search using Google (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring program OR decision support) AND opioid 331 0 January 14, 2020 Regenstrief Institute Regenstrief.org Site search using Google (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring program OR decision support) AND opioid 11 4 January 14, 2020 Canadian Agency for Drugs and Technologies in Health (CADTH) https://www.cadth.ca/ Site search (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring program OR decision support) AND opioid 228 1 January 14, 2020 Institute of Health Economincs http://www.ihe.ca/index.php?/publications Site search Opioid 2 0 January 14, 2020 Pan-Canadian HTA collaborative http://www.crd.york.ac.uk/PanHTA/ Site search Opioid 9 0 January 14, 2020 Programs for Assessment of Technology in Health (Canada) https://www.cadth.ca/ Site search using Google Opioid 0 0 January 14, 2020 The International Network of Agencies for Health Technology Assessment (INATHA) http://www.inahta.org/publications/ Site search Opioid 11 0 January 14, 2020 Agency for Healthcare Research and Quality (AHRQ) https://search.ahrq.gov/search?q=opioid+&search_icon.x=0&search_icon.y=0 Site search using Google Informatics “order entry” phone handheld application reminder alert electronic tool “prescription drug monitoring program” “decision support”AND opioid 103 14 January 14, 2020 Centre for Disease Control (CDC) CDC.gov Site search Opioid “decision support”
Opioid “electronic tool”
Opioid “reminder system”
Opioid “informatics”
Opioid “prescription drug monitoring program”
Opioid “alert”
STOPPED search as no relevant results
Opioid ”application”
Opioid ”tool”
Opioid ”phone”
Opioid ”handheld”151
9
17
243
385
9450
0
0
0
0
0January 14, 2020 Health IT https://www.healthit.gov/ Site search using Google (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring program OR decision support) AND opioid 497 1 January 14, 2020 Healthcare Information and Management Systems Society (HIMSS) HIMSS.org Site search Opioid 231 5 January 14, 2020 Ontario MD OntarioMD.ca Site search Opioid 18 0 January 14, 2020 Health ITanalytics https://www.healthitanalytics.com/ Site search using Google (Informatics OR order entry OR phone OR handheld OR application OR reminder OR alert OR electronic OR tool OR prescription drug monitoring program OR decision support) AND opioid 15 0 January 14, 2020 National Technical Information Service (NTIS) https://www.ntis.gov/ Site search Opioid 0 0 Search Engine Searching
Date Search Engine Search Strategy # screened (Uploaded to citation manager) January 14, 2020 Google advanced search opioid decision support OR electronic OR reminder OR informatics OR alert OR application OR tool OR phone OR handheld First 100 results 37 January 14, 2020 Google advanced search Opioid AND “prescription drug monitoring program” AND “chronic pain” First 100 results 5 *Screening first 100 results.
