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Table 3 Examples of areas of disagreement in the Rules Document and revisions

From: Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Round

Examples of disagreement

Guideline author's reasoning

Revisions made in response

Round one

Strict discontinuation messages based on substance abuse or psychiatric diagnosis

Need to evaluate current status of diagnosis

Updated algorithm to generate all therapeutic options with contraindications for provider to consider and apply based on clinical judgement

Round one

Warning for patients that live >200 miles from VA.

Patients may have continuity of care even if living far away.

Recommendation to not provide opioid therapy and refer patient for care with a local provider was removed

Round two

Dose recommendation for short acting opioids combined with NSAIDs/acetaminophen

Concern about dose of NSAIDs/acetaminophen with medication combinations

Wording of message updated

Round two

Warning about patients with personality disorder

Warn specifically about anti-social and borderline personality disorders

Restricted warnings to persons with these specific personality disorder diagnoses.