Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Gen Intern Med. 2019 Nov;34(11):2414-2420. doi: 10.1007/s11606-019-05239-5. Epub 2019 Sep 4.
We previously developed a pamphlet decision aid (DA) on mammography screening for women ≥ 75 years. However, implementing DAs in primary care may be challenging and may require support from non-physician healthcare team members.
To learn from primary care administrators, nurses, and staff their thoughts on how best to implement a mammography DA for women ≥ 75 years in practice.
Qualitative study entailing in-person individual interviews using a semi-structured interview guide.
Thirty-two non-physician healthcare team members (69.6% of those approached) participated from 8 different primary care practices (community and academic) in the Boston area or in Chapel Hill, NC.
Participants were asked to provide feedback on the DA, their thoughts on ways to make the DA available to older women, and factors that would make it easier and/or harder to implement.
Participants felt the DA was clear, balanced, and understandable, but felt that it needed to be shorter for women with low health literacy. Most participants felt that as long as use of the DA was approved and supported by clinicians that women ≥ 75 years should receive the DA before a visit from staff (usually medical assistants) so that patients could ask their clinicians questions during the visit. Facilitators of DA use included its perceived helpfulness with decision-making, its format, and that existing systems (panel management, electronic medical record alerts) could be accessed to get the DA to patients especially at Medicare Annual Wellness visits. Participants perceived a need for training, albeit minimal, to provide the DA to patients. Barriers of DA use included competing demands on clinician and staff time.
Participants felt that as long as use of the mammography DA for women ≥ 75 years was supported by clinicians, it would be feasible to implement with minimal refinements to existing healthcare system processes.
我们之前开发了一份针对≥75 岁女性乳房 X 光筛查的小册子决策辅助工具（DA）。然而，在初级保健中实施 DAs 可能具有挑战性，并且可能需要非医师医疗团队成员的支持。
了解初级保健管理人员、护士和工作人员对如何在实践中为≥75 岁女性实施乳房 X 光 DA 的最佳想法。
使用半结构化访谈指南进行面对面的个人访谈的定性研究。
来自波士顿地区或北卡罗来纳州教堂山的 8 个不同初级保健实践的 32 名非医师医疗团队成员（接近的人中的 69.6%）参与了研究。
参与者被要求对 DA 提供反馈，对使 DA 可供老年女性使用的方法的想法，以及使其更容易和/或更难实施的因素。
参与者认为 DA 清晰、平衡且易于理解，但认为对于健康素养较低的女性，DA 需要更短。大多数参与者认为，只要使用 DA 得到临床医生的批准和支持，≥75 岁的女性应该在工作人员（通常是医疗助理）就诊前收到 DA，以便患者可以在就诊期间向他们的临床医生提问。使用 DA 的促进因素包括其对决策的帮助、格式以及现有的系统（面板管理、电子病历警报）可以用来将 DA 传递给患者，尤其是在 Medicare 年度健康检查时。参与者认为需要进行培训，尽管培训很少，但需要向患者提供 DA。使用 DA 的障碍包括临床医生和工作人员时间的竞争需求。
参与者认为，只要≥75 岁女性使用乳房 X 光 DA 得到临床医生的支持，就可以在对现有医疗保健系统流程进行最小改进的情况下实施。
