Hasnain Isra, Staab Erin M, Kagarmanova Ainur, Mackiewicz Marissa, Ari Mim, Thompson Katherine, Lazar Danielle, Zhao Anne, Elwyn Glyn, Harle Christopher A, Press Valerie G, Laiteerapong Neda
Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States.
Section of General Internal Medicine, Biological Sciences Division, Department of Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 7738342238.
JMIR Form Res. 2025 Aug 26;9:e74381. doi: 10.2196/74381.
Chronic pain management in older adults can be challenging for primary care clinicians due to comorbidities, side effects, and complicated guideline recommendations. Clinical decision support systems (CDSSs) may improve care by integrating guideline-based recommendations, synthesizing relevant patient data, and facilitating shared decision-making. I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO) is an electronic health record-based CDSS designed to gather patient-reported data and support primary care clinicians in managing chronic pain, opioid use, and opioid use disorder in older adults.
This study examined clinicians' views on challenges in managing chronic pain and their opinions on I-COPE.
We conducted semi-structured interviews with 18 clinicians (16 physicians and 2 advanced practice nurses) from 2 University of Chicago Medicine primary care clinics (internal medicine and geriatrics) piloting the I-COPE CDSSs in 2021. The interview guide was informed by the Consolidated Framework for Implementation Research and explored current practices in chronic pain management, challenges, and feedback on I-COPE tools.
Of the 18 participants, 12 (67%) identified as female, 13 (72%) as White, and 9 (50%) had practiced for 10 years or less. Participants stressed the importance of a comprehensive, patient-centered approach to chronic pain management and prioritized multimodal and nonpharmacological treatments. Major barriers to effective chronic pain management were comorbidities, limited visit time, insurance coverage restrictions, and opioid misuse concerns. Most clinicians found the CDSSs beneficial for standardizing multimodal care discussions, enhancing visit efficiency, eliciting patient goals, and facilitating shared decision-making conversations. Clinicians raised concerns about the complexity of the intervention, anticipated issues with clinic workflow, and desired more adaptability. The primary care clinicians in this study demonstrated strong alignment with current pain management guidelines, prioritizing patient-centered pain management using multimodal treatments. They identified I-COPE as a promising tool to reinforce evidence-based practices, increase efficiency, and strengthen patient-clinician communication. However, implementation challenges-particularly around accessibility for older adults, workflow integration, and tool complexity-highlight the need for further refinement and support.
I-COPE offers a promising approach to support primary care clinicians in providing patient-centered guideline-based chronic pain and opioid management for older adults. Further efforts to improve usability and adaptability for real-world workflows and equitable access for older adults should be prioritized.
由于存在合并症、副作用以及复杂的指南建议，初级保健临床医生对老年人进行慢性疼痛管理可能具有挑战性。临床决策支持系统（CDSS）可通过整合基于指南的建议、综合相关患者数据以及促进共同决策来改善护理。I-COPE（通过以患者为中心的临床决策支持和项目ECHO改善芝加哥老年人阿片类药物和疼痛管理）是一种基于电子健康记录的CDSS，旨在收集患者报告的数据，并支持初级保健临床医生管理老年人的慢性疼痛、阿片类药物使用及阿片类药物使用障碍。
本研究调查了临床医生对慢性疼痛管理挑战的看法以及他们对I-COPE的意见。
我们对来自芝加哥大学医学中心2个初级保健诊所（内科和老年医学科）的18名临床医生（16名医生和2名高级执业护士）进行了半结构化访谈，这些诊所于2021年试用I-COPE CDSS。访谈指南以实施研究综合框架为依据，探讨了慢性疼痛管理的当前实践、挑战以及对I-COPE工具的反馈。
18名参与者中，12名（67%）为女性，13名（72%）为白人，9名（50%）从业时间为10年或更短。参与者强调了采用全面、以患者为中心的方法进行慢性疼痛管理的重要性，并将多模式和非药物治疗列为优先事项。有效慢性疼痛管理的主要障碍包括合并症、就诊时间有限、保险覆盖限制以及对阿片类药物滥用的担忧。大多数临床医生发现CDSS有助于规范多模式护理讨论、提高就诊效率、引出患者目标并促进共同决策对话。临床医生对干预措施的复杂性、诊所工作流程可能出现的问题表示担忧，并希望其具有更高的适应性。本研究中的初级保健临床医生与当前疼痛管理指南高度一致，优先采用以患者为中心的多模式治疗进行疼痛管理。他们认为I-COPE是一种有前景的工具，可加强循证实践、提高效率并加强医患沟通。然而，实施方面的挑战，尤其是在老年人可及性、工作流程整合和工具复杂性方面，凸显了进一步优化和提供支持的必要性。
I-COPE为支持初级保健临床医生为老年人提供以患者为中心的基于指南的慢性疼痛和阿片类药物管理提供了一种有前景的方法。应优先进一步努力提高其在现实世界工作流程中的可用性和适应性，以及老年人的公平可及性。
