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Shared decision making for patients with type 2 diabetes: a randomized trial in primary care
Megan E Branda1, Annie LeBlanc, Nilay D Shah
1Knowledge and Evaluation Research Unit, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
BMC Health Services Research
|August 10, 2013
Summary
Decision aids (DAs) improved patient understanding and engagement in shared decision-making for type 2 diabetes care in rural clinics. While clinical outcomes were not significantly impacted, DAs enhanced the decision-making process for patients.
Area of Science:
- Clinical Medicine
- Primary Care
- Health Services Research
Background:
- Patient-centered diabetes care necessitates shared decision making (SDM).
- The effectiveness of decision aids (DAs) in promoting SDM in nonacademic, rural primary care settings remains under-investigated.
Purpose of the Study:
- To evaluate the impact of point-of-care decision aids on shared decision making and decisional outcomes for patients with type 2 diabetes in rural primary care practices.
Main Methods:
- A cluster-randomized trial involving 10 primary care practices implemented DAs for statin initiation or antihyperglycemic agent selection.
- 103 patients with type 2 diabetes participated, with data collected via patient and clinician surveys, medical records, and pharmacy fill profiles.
- Decisional outcomes included patient knowledge, comfort with decision making, and satisfaction; clinical outcomes assessed metabolic control and medication adherence.
Main Results:
- Patients using DAs were more likely to discuss medications (77% vs. 45%) and demonstrated improved knowledge regarding statin risk reduction and treatment options.
- Clinician engagement in shared decision-making increased significantly for patients using DAs (p=.01).
- No significant impact was observed on patient satisfaction, medication initiation, adherence, or clinical outcomes, potentially due to limited statistical power.
Conclusions:
- Decision aids effectively enhanced decisional outcomes, including patient knowledge and engagement in shared decision-making for type 2 diabetes management.
- DAs are suitable for point-of-care implementation in nonacademic and rural primary care settings to promote patient-centered diabetes care.
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