From the Department of Family and Community Medicine, University of Toronto, Toronto, Canada (SS); Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney; Sydney, Australia (SM); University of St Andrews; St Andrews, United Kingdom (FS); Department of Family and Community Medicine, University of Toronto; Toronto, Canada (FS); Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto, Canada (QG); Department of Family and Community Medicine; Medical Psychiatry Alliance; Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto, Canada (AS); Department of Family and Community Medicine, Women's College Hospital; Toronto, Canada (SH); Department of Family and Community Medicine, University of Toronto; Women's College Research Institute; Toronto, Canada (MAO).
J Am Board Fam Med. 2020 Jul-Aug;33(4):529-540. doi: 10.3122/jabfm.2020.04.190199.
Clinical decision support systems (CDSSs) may help clinicians prescribe opioids for chronic noncancer pain (CNCP) more appropriately. This scoping review determined the extent and range of the current evidence on CDSSs for opioid prescribing for CNCP in primary care, and whether investigators followed best evidence and current guidance in designing, implementing and evaluating these complex interventions.
We searched 9 electronic databases and other data sources for studies from January 1, 2008 to October 11, 2019. Two reviewers independently screened the citations. One reviewer extracted data and a second verified for accuracy.
study of a CDSS for opioid prescribing for CNCP in a primary care clinical setting. We reported quantitative results in tables and qualitative results in narrative form.
Our search yielded 5068 records, of which 14 studies met our inclusion criteria. All studies were conducted in the United States. Six studies examined local (eg, health center) CDSSs and 8 examined prescription drug monitoring program CDSSs. Three CDSSs incorporated evidence-based components. Study aims were heterogeneous and study designs included both quantitative and qualitative methodologies. No studies assessed patient health outcomes. Few studies appeared to be following guidance for evaluating complex interventions.
Few studies have rigorously assessed the use of CDSSs for opioid prescribing for CNCP in primary care settings. Going forward, investigators should include evidence-based components into the design of CDSSs and follow guidance for the development and evaluation of complex interventions.
临床决策支持系统（CDSS）可能有助于临床医生更恰当地为慢性非癌性疼痛（CNCP）患者开具阿片类药物。本范围综述确定了当前关于初级保健中 CDSS 用于阿片类药物治疗 CNCP 的证据的范围和范围，以及研究人员在设计、实施和评估这些复杂干预措施时是否遵循最佳证据和当前指南。
我们从 2008 年 1 月 1 日至 2019 年 10 月 11 日在 9 个电子数据库和其他数据源中搜索了研究。两名审查员独立筛选引文。一名审查员提取数据，另一名审查员验证准确性。
研究 CDSS 用于治疗初级保健临床环境中的 CNCP 患者的阿片类药物处方。我们以表格形式报告定量结果，并以叙述形式报告定性结果。
我们的搜索产生了 5068 条记录，其中 14 项研究符合我们的纳入标准。所有研究均在美国进行。六项研究检查了局部（例如，健康中心）CDSS，八项研究检查了处方药物监测计划 CDSS。三个 CDSS 纳入了基于证据的组成部分。研究目的各不相同，研究设计包括定量和定性方法。没有研究评估患者的健康结果。很少有研究似乎遵循评估复杂干预措施的指南。
很少有研究严格评估了 CDSS 在初级保健环境中用于治疗 CNCP 的阿片类药物处方的使用情况。未来，研究人员应将基于证据的组成部分纳入 CDSS 的设计中，并遵循用于开发和评估复杂干预措施的指南。
