Promoting decision aid use in primary care using a staff member for delivery

Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA.
Patient Education and Counseling (Impact Factor: 2.2). 06/2011; 86(2):189-94. DOI: 10.1016/j.pec.2011.04.033
Source: PubMed


To determine the feasibility and effectiveness of in-clinic decision aid distribution using a care assistant.
We identified potentially eligible patients scheduled for upcoming appointments in our General Internal Medicine Clinic (n=1229). Patients were deemed eligible for two decision aids: prostate cancer screening and/or weight loss surgery. Patients were approached to view the decision aid in-clinic. Our primary measures were the proportion of decision aids distributed to eligible patients, and the proportion of decision aids viewed.
Among 913 patients who attended their scheduled appointments, 58% (n=525) were approached and eligibility was assessed by the staff member. Among the 471 who remained eligible, 57% (n=268) viewed at least a portion of the target decision aid. The mean viewing time for patients who watched less than the complete decision aid was 13 min.
In clinic viewing of decision aids may be a feasible and effective distribution method in primary care.
In clinic distribution requires an electronic health information system to identify potentially eligible patients, and a staff member dedicated to DA distribution. Brief decision aids (less than 10 min) are needed so patients can complete their use prior to the visit to facilitate patient-physician decision making.

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    • "Yet, even in secondary care where it is often possible to predict the clinical decisions that will be needed, the process of ensuring patients use DESIs ahead of encounters is a challenge because the windows of opportunity are often short. Ultimately, the studies indicate that this degree of capital and logistical infrastructure is challenging to initiate and maintain and will require sustained investment [24,28,34,36,37,40]. These issues also make the limits of system-based approaches apparent and highlight the fact that referral by clinicians at the point of care will continue to be necessary for many clinical issues for which decision support is available. "
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