TY - JOUR
T1 - Implementing prescription drug monitoring and other clinical decision support for opioid risk mitigation in a military health care setting
T2 - a qualitative feasibility study
AU - Finley, Erin P.
AU - Schneegans, Suyen
AU - Tami, Claudina
AU - Pugh, Mary Jo
AU - McGeary, Don
AU - Penney, Lauren
AU - Potter, Jennifer Sharpe
N1 - Funding Information:
We acknowledge funding received through the Substance Abuse Working Group of the Joint Program Committee 5/Military Operational Medicine Research Program, US Army Medical Research and Materiel Command (grant #FA8650-15-C-658). The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense, the Department of Veterans Affairs, or its components.
Publisher Copyright:
© The Author 2017.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Objective: Chronic noncancer pain is a highly prevalent condition among service members returning from deployment overseas. The US Army has a higher rate of opioid misuse than the civilian population. Although most states and many health care systems have implemented prescription drug monitoring programs (PDMPs) or other clinician decision support (CDS) to aid providers in delivering guideline-recommended opioid therapy, similar tools are lacking in military health settings. Materials and Methods: We conducted a pre-implementation feasibility and needs assessment guided by the Promoting Action Research in Health Services framework. Twenty-six semistructured interviews were conducted with providers from a large military health system (MHS) to assess baseline knowledge and practices in opioid risk mitigation and providers’ preferences and needs for a military-based PDMP or other CDS. Results: Military health care providers reported complex decision-making around opioid prescribing and monitoring, varied knowledge and use of existing clinical informatics, and concerns about the feasibility of implementing a military-based PDMP in their context. However, providers indicated a need for training and CDS to support opioid risk mitigation for their patients. Discussion: This article describes providers’ knowledge and behaviors around opioid risk mitigation in the MHS, and views on the potential usefulness of a military-based PDMP or other CDS. This pre-implementation study provides a model for using qualitative methods to assess feasibility and inform planning and development of CDS in complex health care settings. Conclusion: Military providers were skeptical regarding the feasibility of MHS-based PDMP implementation, but provided important recommendations for CDS to support safe and appropriate opioid prescribing in military health care.
AB - Objective: Chronic noncancer pain is a highly prevalent condition among service members returning from deployment overseas. The US Army has a higher rate of opioid misuse than the civilian population. Although most states and many health care systems have implemented prescription drug monitoring programs (PDMPs) or other clinician decision support (CDS) to aid providers in delivering guideline-recommended opioid therapy, similar tools are lacking in military health settings. Materials and Methods: We conducted a pre-implementation feasibility and needs assessment guided by the Promoting Action Research in Health Services framework. Twenty-six semistructured interviews were conducted with providers from a large military health system (MHS) to assess baseline knowledge and practices in opioid risk mitigation and providers’ preferences and needs for a military-based PDMP or other CDS. Results: Military health care providers reported complex decision-making around opioid prescribing and monitoring, varied knowledge and use of existing clinical informatics, and concerns about the feasibility of implementing a military-based PDMP in their context. However, providers indicated a need for training and CDS to support opioid risk mitigation for their patients. Discussion: This article describes providers’ knowledge and behaviors around opioid risk mitigation in the MHS, and views on the potential usefulness of a military-based PDMP or other CDS. This pre-implementation study provides a model for using qualitative methods to assess feasibility and inform planning and development of CDS in complex health care settings. Conclusion: Military providers were skeptical regarding the feasibility of MHS-based PDMP implementation, but provided important recommendations for CDS to support safe and appropriate opioid prescribing in military health care.
KW - clinical decision support
KW - feasibility
KW - military health systems
KW - opioid risk mitigation
KW - prescription drug monitoring programs
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U2 - 10.1093/jamia/ocx075
DO - 10.1093/jamia/ocx075
M3 - Article
C2 - 29025024
AN - SCOPUS:85071532600
SN - 1067-5027
VL - 25
SP - 515
EP - 522
JO - Journal of the American Medical Informatics Association : JAMIA
JF - Journal of the American Medical Informatics Association : JAMIA
IS - 5
ER -