Barriers and facilitators to routine distribution of patient decision support interventions: a preliminary study in community-based primary care settings

The decision whether to receive cardiopulmonary resuscitation (CPR) is a decision in which the personal values of the patient must be considered along with information about the risks and benefits of the treatment. A decision aid can be used to provide patient decision support to a patient who is seriously ill and needs to consider CPR options. The goal of this project was to identify the barriers and facilitators to using a CPR decision aid, through evaluating nursing perceptions on providing patient decision support. Using a needs assessment, it was determined that implementing a patient decision aid for CPR status in the Acute Monitor Area (AMA) of The Ottawa Hospital would be an excellent quality improvement project. The nurses who chose to participate were given an education session regarding patient decision support. Questionnaires were distributed to evaluate their views of patient decision support and decision aids before and after the education session and implementation of the CPR decision aid. Questionnaire results did not indicate a significant change between before or after education session and decision aid implementation. Qualitative reports did indicate that nurses generally have positive attitudes toward patient decision support and decision aids. The nurses identified specific barriers and facilitators in their commentaries. This clinically relevant data supports the idea that patient decision support should be integrated into daily nursing practice.

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Implementation of Patient Decision Support Interventions in Primary Care

Medical Decision Making ◽

10.1177/0272989x15602886 ◽

2015 ◽

Vol 35 (8) ◽

pp. 987-998 ◽

Cited By ~ 5

Author(s):

Caroline K. Tietbohl ◽

Katharine A. S. Rendle ◽

Meghan C. Halley ◽

Suepattra G. May ◽

Grace A. Lin ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Patient Decision ◽

Patient Decision Support

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Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

Applied Clinical Informatics ◽

10.1055/s-0040-1715895 ◽

2020 ◽

Vol 11 (04) ◽

pp. 635-643

Author(s):

Joan S. Ash ◽

Dian Chase ◽

Sherry Baron ◽

Margaret S. Filios ◽

Richard N. Shiffman ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Primary Care Providers ◽

Care Providers ◽

Technical Feasibility ◽

Primary Care Settings ◽

Worker Health ◽

Operational Issues

Abstract Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

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Utilization of Patient Decision Support Tools and Processes: The Shared End-Stage Renal Patients Decision Making (SHERPA-DM) Project

Advances in Chronic Kidney Disease ◽

10.1053/j.ackd.2017.02.003 ◽

2017 ◽

Vol 24 (2) ◽

pp. 131

Keyword(s):

Decision Making ◽

Decision Support ◽

Decision Support Tools ◽

Patient Decision ◽

Support Tools ◽

End Stage ◽

Patient Decision Support

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Patient Decision Support Technology

Encyclopedia of Behavioral Medicine ◽

10.1007/978-3-030-39903-0_301389 ◽

2020 ◽

pp. 1638-1638

Keyword(s):

Decision Support ◽

Patient Decision ◽

Decision Support Technology ◽

Patient Decision Support

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Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2019-100088 ◽

2019 ◽

Vol 26 (1) ◽

pp. e100088

Author(s):

Rebecca G Mishuris ◽

Joseph Palmisano ◽

Lauren McCullagh ◽

Rachel Hess ◽

David A Feldstein ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Clinical Decision ◽

Process Theory ◽

Normalisation Process Theory ◽

Implementation Barriers ◽

Clinical Workflow ◽

Primary Care Settings ◽

Registration Number

BackgroundEffective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of ‘work’ necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and ‘work’ of implementation of two clinical decision support (CDS) tools across diverse care settings.MethodsWe conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions’ primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time.ResultsThe median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers’ participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008).ConclusionsThis study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies.Trial registration numberNCT02534987.

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