Decision Aids in the United States: the Patient Response

2015 ◽  
Vol 5 (3) ◽  
pp. 105-111
Author(s):  
Richard Wexler ◽  
Bethany S. Gerstein ◽  
Charles Brackett ◽  
Lyle J. (LJ) Fagnan ◽  
Kathleen M. Fairfield ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Decision Making ◽  
Formal Education ◽  
Decision Aids ◽  
Clinical Information ◽  
The United States ◽  
Care Practice ◽  
Or Education ◽  
Patient Response

Background:  In the United States and elsewhere, a growing chorus of voices is calling for the routine use of patient decision aids (DAs) and shared decision making (SDM) in day-to-day care.  A frequently cited barrier to this approach is the belief that many patients will not be able to understand key clinical information and/or prefer to delegate decision making to providers.  These beliefs, often held by providers, are thought to be particularly applicable to elderly and less educated patients.Objectives: To test the perception that older and less educated patients will not value or benefit from DAs.Research design: Self-administered questionnaires completed by patients after viewing DAs.Subjects: 3001 patients in six primary care practice sites facing one of sixteen common medical decisions.Measures: Amount of DA viewed, knowledge about medical tests or treatments, DA rating, and importance of receiving DAs from providers.Results: Across age and education level, higher self-reported exposure to the DAs was associated with higher knowledge scores. Those over 65 and those who had not attended college had knowledge gains at least has high as those in other groups. There were no statistically significant differences by age or education in patient assessment of the importance of using DAs.Conclusions: Patients in primary care settings in the U.S. learn from DAs, rate them highly, and believe that providers should make them available in ways that are mainly independent of patient age or formal education.

Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review

2019 ◽  
Vol 77 (5) ◽  
pp. 387-401 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Lusine Poghosyan
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Organizational Level ◽  
Care Practice ◽  
Practice Environment ◽  
Care Providers ◽  
Cross Sectional ◽  
Study Designs

Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute’s critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.

scholarly journals Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic

2020 ◽  
Vol 39 (9) ◽  
pp. 1605-1614 ◽  
Author(s):  
Sanjay Basu ◽  
Russell S. Phillips ◽  
Robert Phillips ◽  
Lars E. Peterson ◽  
Bruce E. Landon
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Practice ◽  
The United States ◽  
Care Practice

An Emerging Model of Primary Care for Older Adults: The House Call–Home Care Practice

2009 ◽  
Vol 10 (3) ◽  
pp. 110-114 ◽  
Author(s):  
Steven H. Landers ◽  
Paul W. Gunn ◽  
Kurt C. Stange
Keyword(s):  
United States ◽  
Older Adults ◽  
Primary Care ◽  
Home Care ◽  
Nurse Practitioners ◽  
The United States ◽  
Care Practice ◽  
House Calls ◽  
House Call ◽  
Care Practices

House calls to older adults have become more common, in part related to the emergence of medical practices that either emphasize or exclusively provide house calls. In this article we seek to describe organizational, clinician, and patient characteristics of house call–home medical care practices in the United States. We conducted telephone interviews with clinicians representing 36 randomly selected practices from across the United States. This study found that house call–home care practices typically are recently formed small groups of physicians and nurse practitioners that provide in-home primary care, especially chronic disease care, to Medicare beneficiaries. Clinicians are motivated by the opportunity to improve care and to maintain autonomy. This emerging model may represent a mutually beneficial trend for older adults and physicians.

scholarly journals Staying Home, Distancing, and Face Masks: COVID-19 Prevention among U.S. Women in The COPE Study

2020 ◽  
Vol 18 (1) ◽  
pp. 180
Author(s):  
Katherine M. Anderson ◽  
Jamila K. Stockman
Keyword(s):  
United States ◽  
Decision Making ◽  
Cultural Context ◽  
Online Survey ◽  
Formal Education ◽  
Face Mask ◽  
The United States ◽  
Urban Environments ◽  
Behavior Modeling ◽  
Prevention Behavior

The novel coronavirus (COVID-19) pandemic has significantly impacted United States residents. Prevention behaviors are critical to minimizing transmission of SARS-CoV-2 in the U.S., to ultimately reduce the health, social, and economic burdens of COVID-19. Yet, health behavior decision-making is complex, and uptake of preventative behaviors has been variable. Women may provide pro-prevention behavior modeling to their networks, facilitating uptake diffusion. The COPE Study enrolled 491 women residing in the United States from May to June of 2020; women completed an online survey of COVID-19 experiences and prevention behaviors. We employed binary logistic modeling to identify factors predicting women’s practice of (1) staying home except for essential activities, (2) physical distancing in public, and (3) wearing a face mask in public. Findings demonstrate that women’s prevention behaviors are influenced by multilevel factors. Women living in urban environments, having minimal formal education, or having a household annual income of USD 30,000–50,000 are less likely to practice prevention behaviors. Cultural context may be an important factor in the decision-making process. Results aid in the identification what interventional “levers” may warrant consideration to promote uptake of such behaviors, and whom to engage. Because women are modelers of behavior, it is critical to engage them in prevention behavior interventions.

Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study

2022 ◽  
Vol 13 (01) ◽  
pp. 001-009
Author(s):  
Nicole Puccinelli-Ortega ◽  
Mark Cromo ◽  
Kristie L. Foley ◽  
Mark B. Dignan ◽  
Ajay Dharod ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Decision Aids ◽  
Informed Decision ◽  
Care Practice ◽  
Informed Decision Making ◽  
Structured Interviews ◽  
Clinic Staff ◽  
Facilitators And Barriers

Abstract Background Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka “app”) to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid. Objective The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics. Design This work deals with a multicenter qualitative study in rural and urban settings. Participants A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff. Approach Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis. Key Results Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information. Conclusion Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability. NIH trial registry number R01CA218416-A1.

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