Evaluating Physical and Occupational Therapists’ and Assistants’ Experiences Implementing an Electronic Health Record-Based Intervention to Support Perioperative Patients’ Use of Nonpharmacological Pain Management Techniques

Abstract

Objective

To explore barriers and facilitators experienced by therapists (physical therapists/assistants and occupational therapists/assistants) supporting the implementation of the electronic health record (EHR)-based Healing After Surgery (HAS) initiative, which used clinical decision support (CDS) elements to support therapists in providing perioperative education and support to patients for the use of evidence-based nonpharmacological pain care (NPPC) techniques as part of a health system-wide clinical trial.

Design

A cross-sectional web-based survey.

Setting

Three academic and 3 community-based hospitals from the same health system.

Participants

Therapists (N=236) who delivered the EHR-based HAS initiative.

Interventions

Not applicable.

Main Outcome Measures

Barriers and facilitators that therapists experienced implementing the EHR-based HAS initiative.

Results

We received survey responses from therapists (34.6% response rate). Using a numerical rating scale (1=not at all, 10=a great deal), therapists reported the highest agreement to questions regarding understanding the goal of the initiative (mean ± SD, 7.3±2.4) and alignment of the initiative with therapy practice (mean ± SD, 7.2±2.4), followed by alignment with patient needs (mean ± SD, 6.7±2.4). Ratings were slightly lower for understanding of their role (mean ± SD, 6.5±2.3), leadership support (mean ± SD, 6.3±2.4), and adequacy of training (mean ± SD, 6.2±2.4). Therapists rated the helpfulness of CDS elements at the midpoint of the scale, with mean ratings ranging from 5.0 to 5.1. Only 27% of therapists felt equipped to educate patients on all NPPC techniques.

Conclusions

The EHR-based HAS initiative was perceived to align with standard therapy care. However, many therapists did not feel equipped to support all NPPC techniques. Similar future efforts should address additional training needs and CDS refinement.