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Shared decision making and medication therapy management with the use of an interactive template

Published:February 18, 2016DOI:https://doi.org/10.1016/j.japh.2015.12.013

      Abstract

      Objectives

      To evaluate the preliminary efficacy, feasibility, and acceptability of a template-based intervention to facilitate shared decision making (SDM) in medication therapy management (MTM) consultations; and to examine the type and number of drug therapy problems (DTPs) discussed and how resolution was communicated to patients' primary care providers (PCPs).

      Setting

      An internal medicine clinic at a large safety-net hospital.

      Practice description

      Hennepin County Medical Center is an urban safety net hospital serving an ethnically-diverse population with about 50 percent of patients enrolled in Medicaid. Within its internal medicine clinic, the study setting, over 100 clinicians participate in the primary care of approximately 25,000 discrete patients.

      Practice innovation

      This is the first study to use a template format to facilitate SDM with pharmacists in MTM consultations. The template approach is more flexible than the use of decision aids, facilitating discussion around various issues.

      Interventions

      Patients completed template-guided interventions with pharmacists trained in SDM.

      Evaluation

      We analyzed the electronic health record used during the intervention, as well as post-appointment surveys administered to patients and pharmacists, for indications of SDM efficacy, feasibility, and acceptability.

      Results

      Twenty patients and four pharmacists participated in the study. Free-text comments demonstrated that both patients and pharmacists appreciated the intervention, although some pharmacists had concerns including consultation length and SDM applicability. On average, two DTPs were identified per consultation and were most commonly related to appropriate compliance (30% of DTPs), appropriate indication (26%), medication effectiveness (23%), and safety (21%).

      Conclusion

      Using a template to facilitate SDM within MTM consultations appears to be effective, feasible, and acceptable. DTP identification exemplifies a potential application of template-guided SDM. These results will be used to inform future work refining the intervention and developing robust comparative analyses.
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      References

      1. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Available at: http://www.nap.edu/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the. Accessed May 28, 2015.

        • Lindhiem O.
        • Bennett C.B.
        • Trentacosta C.J.
        • McLear C.
        Client preferences affect treatment satisfaction, completion, and clinical outcome: a meta-analysis.
        Clin Psychol Rev. 2014; 34: 506-517
        • Barry M.J.
        • Edgman-Levitan S.
        Shared decision making—pinnacle of patient-centered care.
        N Engl J Med. 2012; 366: 780-781
        • Elwyn G.
        • Lloyd A.
        • May C.
        • et al.
        Collaborative deliberation: a model for patient care.
        Patient Educ Couns. 2014; 97: 158-164
        • Elwyn G.
        • Frosch D.
        • Thomson R.
        • et al.
        Shared decision making: a model for clinical practice.
        J Gen Intern Med. 2012; 27: 1361-1367
        • Duncan E.
        • Best C.
        • Hagen S.
        Shared decision making interventions for people with mental health conditions.
        Cochrane Database Syst Rev. 2010; : CD007297
        • Perestelo-Perez L.
        • Gonzalez-Lorenzo M.
        • Perez-Ramos J.
        • Rivero-Santana A.
        • Serrano-Aguilar P.
        Patient involvement and shared decision-making in mental health care.
        Curr Clin Pharmacol. 2011; 6: 83-90
        • Gilbody S.M.
        • Whitty P.M.
        • Grimshaw J.M.
        • Thomas R.E.
        Improving the detection and management of depression in primary care.
        Qual Saf Health Care. 2003; 12: 149-155
        • Elwyn G.
        • Tilburt J.
        • Montori V.
        The ethical imperative for shared decision-making.
        Eur J Pers Centered Healthc. 2013; 1: 129-131
        • Stiggelbout A.M.
        • van der Weijden T.
        • de Wit M.P.T.
        • et al.
        Shared decision making: really putting patients at the centre of healthcare.
        BMJ. 2012; 344: e256
        • Elwyn G.
        • Scholl I.
        • Tietbohl C.
        • et al.
        “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice.
        BMC Med Inform Decis Mak. 2013; 13: S14
        • US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
        Shared decision-making in mental health care: practice, research, and future directions.
        2010 (Available at:) (Accessed September 22, 2015)
        • Insel T.R.
        Assessing the economic costs of serious mental illness.
        Am J Psychiatry. 2008; 165: 663-665
        • Narrow W.E.
        • Rae D.S.
        • Robins L.N.
        • Regier D.A.
        Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates.
        Arch Gen Psychiatry. 2002; 59: 115-123
        • Soni A.
        The five most costly conditions, 1996 and 2006: estimates for the U.S. civilian noninstitutionalized population.
        Agency for Healthcare Research and Quality, 2009 (Available at:) (Accessed May 28, 2015)
        • Cramer J.A.
        • Rosenheck R.
        Compliance with medication regimens for mental and physical disorders.
        Psychiatr Serv. 1998; 49: 196-201
        • Corrigan P.W.
        • Liberman R.P.
        • Engel J.D.
        From noncompliance to collaboration in the treatment of schizophrenia.
        Psychiatr Serv. 1990; 41: 1203-1211
        • Kent S.
        • Yellowlees P.
        Psychiatric and social reasons for frequent rehospitalization.
        Hosp Community Psychiatry. 1994; 45: 347-350
        • Svarstad B.L.
        • Shireman T.I.
        • Sweeney J.K.
        Using drug claims data to assess the relationship of medication adherence with hospitalization and costs.
        Psychiatr Serv. 2001; 52: 805-811
        • Wilson S.R.
        • Strub P.
        • Buist A.S.
        • et al.
        Shared treatment decision making improves adherence and outcomes in poorly controlled asthma.
        Am J Respir Crit Care Med. 2010; 181: 566-577
        • Raue P.J.
        • Schulberg H.C.
        • Heo M.
        • Klimstra S.
        • Bruce M.L.
        Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study.
        Psychiatr Serv Wash DC. 2009; 60: 337-343
        • Légaré F.
        • Politi M.C.
        • Drolet R.
        • et al.
        Training health professionals in shared decision-making: an international environmental scan.
        Patient Educ Couns. 2012; 88: 159-169
        • Chong W.W.
        • Aslani P.
        • Chen T.F.
        Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.
        J Interprof Care. 2013; 27: 223-230
        • Légaré F.
        • Witteman H.O.
        Shared decision making: examining key elements and barriers to adoption into routine clinical practice.
        Health Aff Proj Hope. 2013; 32: 276-284
        • Makoul G.
        • Clayman M.L.
        An integrative model of shared decision making in medical encounters.
        Patient Educ Couns. 2006; 60: 301-312
        • Elwyn G.
        • Hutchings H.
        • Edwards A.
        • et al.
        The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks.
        Health Expect. 2005; 8: 34-42
        • Kriston L.
        • Scholl I.
        • Hölzel L.
        • Simon D.
        • Loh A.
        • Härter M.
        The 9-Item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample.
        Patient Educ Couns. 2010; 80: 94-99
      2. Ottawa Hospital Research Institute, University of Ottawa. Ottawa personal decision guide. Available at: https://decisionaid.ohri.ca/docs/das/OPDG.pdf. Accessed May 27, 2015.

      3. Institute for Clinical Systems Improvement. ICSI shared decision-making model. Available at: https://www.icsi.org/_asset/0vs54w/What-is-Shared-Decision-Making-042412.pdf.

        • Wyatt K.D.
        • Branda M.E.
        • Anderson R.T.
        • et al.
        Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters.
        Implement Sci. 2014; 9: 26
        • Charles C.
        • Gafni A.
        • Whelan T.
        Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model.
        Soc Sci Med. 1999; 49: 651-661
      4. Edwards A. Elwyn G. Shared decision-making in health care: Achieving evidence-based patient choice. 2nd ed. Oxford University Press, Oxford2009

      Biography

      Katherine Montag Schafer, PharmD, Hennepin County Medical Center, Minneapolis, MN; Center for Patient and Provider Experience, Hennepin County Medical Center, Minneapolis, MN; now at Mayo Clinic, Rochester, MN

      Biography

      Michael R. Gionfriddo, PharmD, Mayo Graduate School, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN

      Biography

      Deborah H. Boehm, MPH, CNP, Hennepin County Medical Center, Minneapolis, MN; Center for Patient and Provider Experience, Hennepin County Medical Center, Minneapolis, MN; now at the Minneapolis Medical Research Foundation, Minneapolis, MN