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Developing a clinical decision support for opioid use disorders: a NIDA center for the clinical trials network working group report

Authors
  • Bart, Gavin B.1
  • Saxon, Andrew2, 3
  • Fiellin, David A.4
  • McNeely, Jennifer5
  • Muench, John P.6
  • Shanahan, Christopher W.7
  • Huntley, Kristen8
  • Gore-Langton, Robert E.9
  • 1 University of Minnesota, 701 Park Avenue, Minneapolis, MN, 55415, USA , Minneapolis (United States)
  • 2 University of Washington, Seattle, USA , Seattle (United States)
  • 3 VA Puget Sound Health Care System–Seattle Division, 1660 S. Columbian Way, Seattle, WA, 98108-1597, USA , Seattle (United States)
  • 4 Yale University School of Medicine, E.S. Harkness Building A, 367 Cedar Street, Suite 406A, New Haven, CT, 06510, USA , New Haven (United States)
  • 5 NYU School of Medicine, 180 Madison Ave., New York, NY, 10016, USA , New York (United States)
  • 6 Oregon Health & Science University, 3930 SE Division Street, Portland, OR, 97202, USA , Portland (United States)
  • 7 Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA , Boston (United States)
  • 8 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA , Bethesda (United States)
  • 9 The Emmes Company, Rockville, MD, USA , Rockville (United States)
Type
Published Article
Journal
Addiction Science & Clinical Practice
Publisher
BioMed Central
Publication Date
Jan 16, 2020
Volume
15
Issue
1
Identifiers
DOI: 10.1186/s13722-020-0180-2
Source
Springer Nature
Keywords
License
Green

Abstract

There is an urgent need for strategies to address the US epidemic of prescription opioid, heroin and fentanyl-related overdoses, misuse, addiction, and diversion. Evidence-based treatment such as medications for opioid use disorder (MOUD) are available but lack numbers of providers offering these services to meet the demands. Availability of electronic health record (EHR) systems has greatly increased and led to innovative quality improvement initiatives but this has not yet been optimized to address the opioid epidemic or to treat opioid use disorder (OUD). This report from a clinical decision support (CDS) working group convened by the NIDA Center for the Clinical Trials Network aims to converge electronic technology in the EHR with the urgent need to improve screening, identification, and treatment of OUD in primary care settings through the development of a CDS algorithm that could be implemented as a tool in the EHR. This aim is consistent with federal, state and local government and private sector efforts to improve access and quality of MOUD treatment for OUD, existing clinical quality and HEDIS measures for OUD or drug and alcohol use disorders, and with a recent draft grade B recommendation from the US Preventative Services Task Force (USPSTF) for screening for illicit drug use in adults when appropriate diagnosis, treatment and care services can be offered or referred. Through a face-to-face expert panel meeting and multiple follow-up conference calls, the working group drafted CDS algorithms for clinical care felt to be essential for screening, diagnosis, and management of OUD in primary care. The CDS algorithm was reviewed by addiction specialists and primary care providers and revised based on their input. A clinical decision support tool for OUD screening, assessment, and treatment within primary care systems may help improve healthcare delivery to help address the current epidemic of opioid misuse and overdose that has outpaced the capacity of specialized treatment settings. A semi-structured outline of clinical decision support for OUD was developed to facilitate implementation within the EHR. Further work for adaptation at specific sites and for testing is needed.

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