A pilot study of the functionality and clinician acceptance of a clinical decision support tool to improve primary care of opioid use disorder.

This is the Primary Outcomes Article for CTN-0076-Ot.

Most Americans with opioid use disorder (OUD) do not receive indicated medical care. A clinical decision support (CDS) tool for primary care providers (PCPs) could address this treatment gap. The primary objective of this study was to build an OUD-CDS tool, based on a NIDA Blending Initiative paper, and demonstrate its functionality and accuracy. Secondary objectives were to achieve high use and approval rates and improve PCP confidence in diagnosing and treating OUD.

A convenience sample of 55 PCPs participated. Buprenorphine-waivered PCPs (n=8) were assigned to the intervention. Non-waivered PCPs (n=47) were randomized to intervention (n=24) or control (n=23). Intervention PCPs received access to the OUD-CDS, which alerted them to patients at potentially increased risk for OUD or overdose and guided diagnosis and treatment. Control PCPs provided care as usual.

The OUD-CDS was functional and accurate following extensive multi-phased testing. PCPs used the OUD-CDS in 5% of encounters with at-risk patients, far less than the goal of 60%. OUD screening confidence increased for all intervention PCPs and OUD diagnosis increased for non-waivered intervention PCPs. Most PCPs (65%) would recommend the OUD-CDS and found it helpful with screening for OUD and discussing and prescribing OUD medications.

Conclusions: The OUD-CDS tool was functional and accurate, but PCP use rates were low. Despite low use, however, the OUD-CDS improved confidence in OUD screening, diagnosis, and use of buprenorphine. A large multi-site study (CTN-0095) is in progress that will incorporate PCP feedback to make the OUD-CDS more intuitive and simple and will include implementation strategies to achieve higher CDS use.

Related protocols: CTN-0076-Ot