Knowledge and Evaluation Research Unit, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
BMC Health Serv Res. 2013 Aug 8;13:301. doi: 10.1186/1472-6963-13-301.
Patient-centered diabetes care requires shared decision making (SDM). Decision aids promote SDM, but their efficacy in nonacademic and rural primary care clinics is unclear.
We cluster-randomized 10 practices in a concealed fashion to implement either a decision aid (DA) about starting statins or one about choosing antihyperglycemic agents. Each practice served as a control group for another practice implementing the other type of DA. From April 2011 to July 2012, 103 (DA=53) patients with type 2 diabetes participated in the trial. We used patient and clinician surveys administered after the clinical encounter to collect decisional outcomes (patient knowledge and comfort with decision making, patient and clinician satisfaction). Medical records provided data on metabolic control. Pharmacy fill profiles provided data for estimating adherence to therapy.
Compared to usual care, patients receiving the DA were more likely to report discussing medications (77% vs. 45%, p<.001), were more likely to answer knowledge questions correctly (risk reduction with statins 61% vs. 33%, p=.07; knowledge about options 57% vs. 33%, p=.002) and were more engaged by their clinicians in decision making (50. vs. 28, difference 21.4 (95% CI 6.4, 36.3), p=.01). We found no significant impact on patient satisfaction, medication starts, adherence or clinical outcomes, in part due to limited statistical power.
DAs improved decisional outcomes without significant effect on clinical outcomes. DAs designed for point-of-care use with type 2 diabetes patients promoted shared decision making in nonacademic and rural primary care practices.
NCT01029288.
以患者为中心的糖尿病护理需要共同决策（SDM）。决策辅助工具可促进 SDM，但它们在非学术和农村初级保健诊所的效果尚不清楚。
我们以隐藏的方式对 10 个实践进行聚类随机分组，以实施关于开始使用他汀类药物或选择抗高血糖药物的决策辅助工具（DA）。每个实践都作为实施另一种 DA 的另一个实践的对照组。从 2011 年 4 月至 2012 年 7 月，共有 103 名（DA=53）2 型糖尿病患者参加了试验。我们使用临床就诊后进行的患者和临床医生调查来收集决策结果（患者对决策的了解和舒适度、患者和临床医生的满意度）。医疗记录提供了代谢控制数据。药房配药记录提供了估计治疗依从性的数据。
与常规护理相比，接受 DA 的患者更有可能讨论药物（77%对 45%，p<.001），更有可能正确回答知识问题（他汀类药物降低风险 61%对 33%，p=.07；了解选项 57%对 33%，p=.002），并且更能让他们的临床医生参与决策（50%对 28%，差异 21.4（95%CI 6.4,36.3），p=.01）。我们没有发现对患者满意度、药物起始、依从性或临床结果有显著影响，部分原因是统计能力有限。
DA 改善了决策结果，而对临床结果没有显著影响。为 2 型糖尿病患者设计的、用于即时使用的 DA 在非学术和农村初级保健实践中促进了共同决策。
NCT01029288。
