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  • 1
    Online Resource
    Online Resource
    Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions
    Informa UK Limited ; 2015
    In:  Patient Related Outcome Measures
    Details
    In: Patient Related Outcome Measures, Informa UK Limited
    Type of Medium: Online Resource
    ISSN: 1179-271X
    URL: Journal
    URL: Article
    DOI: 10.2147/PROM
    DOI: 10.2147/PROM.S78955
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2015
    detail.hit.zdb_id: 2586660-6
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  • 2
    Online Resource
    Online Resource
    Shared decision making for patients with type 2 diabetes: a randomized trial in primary care
    Springer Science and Business Media LLC ; 2013
    In:  BMC Health Services Research Vol. 13, No. 1 ( 2013-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2013-12)
    Abstract: Patient-centered diabetes care requires shared decision making (SDM). Decision aids promote SDM, but their efficacy in nonacademic and rural primary care clinics is unclear. Methods We cluster-randomized 10 practices in a concealed fashion to implement either a decision aid (DA) about starting statins or one about choosing antihyperglycemic agents. Each practice served as a control group for another practice implementing the other type of DA. From April 2011 to July 2012, 103 (DA=53) patients with type 2 diabetes participated in the trial. We used patient and clinician surveys administered after the clinical encounter to collect decisional outcomes (patient knowledge and comfort with decision making, patient and clinician satisfaction). Medical records provided data on metabolic control. Pharmacy fill profiles provided data for estimating adherence to therapy. Results Compared to usual care, patients receiving the DA were more likely to report discussing medications (77% vs. 45%, p 〈 .001), were more likely to answer knowledge questions correctly (risk reduction with statins 61% vs. 33%, p=.07; knowledge about options 57% vs. 33%, p=.002) and were more engaged by their clinicians in decision making (50. vs. 28, difference 21.4 (95% CI 6.4, 36.3), p=.01). We found no significant impact on patient satisfaction, medication starts, adherence or clinical outcomes, in part due to limited statistical power. Conclusion DAs improved decisional outcomes without significant effect on clinical outcomes. DAs designed for point-of-care use with type 2 diabetes patients promoted shared decision making in nonacademic and rural primary care practices. Trial Registration NCT01029288
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/1472-6963-13-301
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 2050434-2
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  • 3
    Online Resource
    Online Resource
    Lessons learned from the conduct of a multisite cluster randomized practical trial of decision aids in rural and suburban primary care practices
    Springer Science and Business Media LLC ; 2013
    In:  Trials Vol. 14, No. 1 ( 2013-12)
    Details
    In: Trials, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2013-12)
    Abstract: The decision aids for diabetes (DAD) trial explored the feasibility of testing the effectiveness of decision aids (DAs) about coronary prevention and diabetes medications in community-based primary care practices, including rural clinics that care for patients with type 2 diabetes. Methods As originally designed, we invited clinicians in eight practices to participate in the trial, reviewed the patient panel of clinicians who accepted our invitation for potentially eligible patients, and contacted these patients by phone, enrolling those who accepted our invitation. As enrollment failed to meet targets, we recruited four new practices. After discussing the study with the clinicians and receiving their support, we reviewed all clinic panels for potentially eligible patients. Clinicians were approached to confirm participation and patient eligibility, and patients were approached before their visit to provide written informed consent. This in-clinic approach required study coordinators to travel and stay longer at the clinics as well as to screen more patient records for eligibility. The in-clinic approach was associated with better recruitment rates, lower patient retention and outcome completion rates, and a better intervention effect. Results We drew four lessons: 1) difficulties identifying potentially eligible patients threaten the viability of practical trials of DAs; 2) to improve the recruitment yield, recruit clinicians and patients for the study at the clinic, just before their visit; 3) approaches that improve recruitment may be associated with reduced retention and survey response; and 4) procedures that involve working closely with the practice may improve recruitment and may also affect the quality of the implementation of the interventions. Conclusion Success in practice-based trials in usual primary care including rural clinics may require the smallest possible research footprint on the practice while implementing a streamlined protocol favoring in-clinic, in-person interactions with clinicians and patients. Trial registration ClinicalTrials.gov NCT01029288
    Type of Medium: Online Resource
    ISSN: 1745-6215
    URL: Article
    DOI: 10.1186/1745-6215-14-267
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 2040523-6
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  • 4
    Online Resource
    Online Resource
    The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial
    Springer Science and Business Media LLC ; 2012
    In:  BMC Health Services Research Vol. 12, No. 1 ( 2012-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2012-12)
    Abstract: Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient’s values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. Methods/Design We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid ( Statin Choice and Aspirin Choice, or Diabetes Medication Choice ) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Discussion Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. Trial registration NCT00388050
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/1472-6963-12-130
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2050434-2
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