Factors associated with chronic pain clinical decision support use in primary care

Clinical Decision Support (CDS), despite its potential to enhance healthcare quality, faces persistently low use. Prior research, often relying on self-reported data, has largely overlooked how clinician characteristics, such as gender and years in practice, moderate CDS use. We examined the moderating role of primary care clinician (PCC) characteristics on the relationship between patient-encounter characteristics and CDS use. We analyzed electronic health record data from a pragmatic randomized controlled trial (October 2019-May 2022) involving 69 PCCs with access to a CDS for managing chronic non-cancer pain (OneSheet). Our primary outcome was OneSheet use at a patient-encounter, defined as access within three days before or after an encounter. Independent variables included encounters for new patients, patients with chronic pain diagnoses, patients prescribed long-term opioid therapy (LTOT), and previous PCC OneSheet use. Generalized linear models with interaction terms tested PCC gender and years in practice as moderators. PCCs used OneSheet in 959 of 145,511 encounters (0.7%). Use was less likely for encounters with new patients (-0.42 percentage points (pp); 95% confidence interval (CI) -0.65, -0.19) but more likely for encounters with chronic pain diagnoses (3.48 pp; 95% CI 2.62, 4.33) and patients prescribed LTOT (4.70 pp; 95% CI 3.57, 5.84). Prior OneSheet use did not predict future use (0.30 pp; 95% CI -0.00, 0.06). Relationships were strongest among female PCCs with over 16 years of practice. Optimizing CDS use requires prioritizing clinical relevance and considering the diverse characteristics of clinicians.