Tong Wen Ting, Ng Chirk Jenn, Lee Yew Kong, Lee Ping Yein
Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Centre for Behavioural and Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
BMC Health Serv Res. 2025 Mar 27;25(1):450. doi: 10.1186/s12913-025-12588-x.
Literature surrounding patient decision aid (PDA) focus on testing effectiveness such as measuring patient or practice outcomes, while few studies looked into evaluation of implementation outcomes. It is important to assess implementation outcomes because in order for PDA to deliver its intended effects, they should first be effectively implemented. This study aimed to evaluate the implementation of an insulin PDA in an academic primary care clinic specifically measuring implementation outcomes.
A mixed-methods sequential explanatory design was used. This study was conducted at a primary care clinic in an academic hospital from April - November 2018. The insulin PDA was implemented using a tailored implementation intervention, which comprised of 11 strategies aiming to overcome 13 prioritised implementation barriers. Evaluation data were collected from: healthcare administrators such as the head of department, the clinic coordinator, and the nursing officer who oversees the clinic operations, doctors whose tasks were to deliver the insulin PDA to patients, nurses who were responsible for making sure the insulin PDAs were available, and patients with type 2 diabetes who were offered the insulin PDA. The study commenced with the quantitative approach to assess 'Reach', 'Adoption', 'Implementation' and 'Maintenance'of the insulin PDA. Subsequently, qualitative approach was employed and qualitative interviews were conducted with the relevant stakeholders to explain the quantitative outcomes. A total of six IDIs and six FGDs were conducted with healthcare providers (healthcare policymakers: 3, doctors: 35, and staff nurses: 5), and 62 IDIs were conducted with patients.
For 'Reach', 88.9% (n = 48/54) of doctors and 55% (n = 11/20) of nurses attended the insulin PDA training workshops. This was attributed to their self-motivation and the mandate from the Head of Department. The PDA reached 387 patients and was facilitated by the doctors who delivered the PDA to them and their own desire to know more about insulin. Doctors' 'Adoption' of the PDA was high (83.3%, n = 45/54) due to the positive personal experience with the usefulness of the PDA. Only 65.7% (n = 94/143) of patients who received the PDA read it. The degree of 'Implementation' of the PDA varied for different tasks (ranged from 19.2 to 84.9%) and was challenged by patient and system barriers. For 'Maintenance', 80% of the doctors were willing to continue using the PDA due to its benefits.
This study highlighted that the implementation of an insulin PDA in a primary care setting is promising. Addressing the issues of social hierarchy, and healthcare providers' roles and responsibilities can further improve implementation outcomes.
关于患者决策辅助工具（PDA）的文献主要集中在测试其有效性，如衡量患者或实践结果，而很少有研究关注实施结果的评估。评估实施结果很重要，因为为了使PDA发挥预期效果，首先应有效地实施它们。本研究旨在评估胰岛素PDA在学术初级保健诊所的实施情况，特别关注实施结果的测量。
采用混合方法序列解释性设计。本研究于2018年4月至11月在一家学术医院的初级保健诊所进行。胰岛素PDA通过量身定制的实施干预措施进行实施，该干预措施包括11项策略，旨在克服13个优先排序的实施障碍。评估数据收集自：医疗保健管理人员，如部门负责人、诊所协调员和监督诊所运营的护理人员；负责向患者提供胰岛素PDA的医生；负责确保胰岛素PDA可用的护士；以及接受胰岛素PDA的2型糖尿病患者。该研究首先采用定量方法评估胰岛素PDA的“覆盖范围”“采用情况”“实施情况”和“维持情况”。随后，采用定性方法，与相关利益相关者进行定性访谈，以解释定量结果。共对医疗保健提供者（医疗保健政策制定者：3人、医生：35人、护士：5人）进行了6次个人深度访谈和6次焦点小组讨论，并对患者进行了62次个人深度访谈。
在“覆盖范围”方面，88.9%（n = 48/54）的医生和55%（n = 11/20）的护士参加了胰岛素PDA培训研讨会。这归因于他们的自我激励和部门负责人的要求。PDA覆盖了387名患者，这得益于向他们提供PDA的医生以及患者自身对了解更多胰岛素知识的渴望。由于对PDA有用性的积极个人体验，医生对PDA的“采用率”很高（83.3%，n = 45/54）。接受PDA的患者中只有65.7%（n = 94/143）阅读了它。PDA在不同任务中的“实施程度”各不相同（范围从19.2%到84.9%），并受到患者和系统障碍的挑战。在“维持情况方面”，80%的医生由于其益处而愿意继续使用PDA。
本研究强调在初级保健环境中实施胰岛素PDA是有前景的。解决社会等级制度以及医疗保健提供者的角色和责任问题可以进一步改善实施结果。
