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Monday, October 20, 2008
Columbus A-C (Hyatt Regency Penns Landing)
OBJECTIVE: Patients with type 2 diabetes do not participate in making choices about diabetes medications. We developed a decision aid for patients with poorly controlled diabetes consisting of an innovative set of 6 issue cards that describe the impact five common medications have on A1c level, the incidence of hypoglycemia, weight changes, daily routine, blood sugar monitoring and side effects.
METHODS: We conducted a clustered randomized trial at 11 primary care and family medicine clinics in Southeastern Minnesota. Eligible patients had type 2 diabetes for ≥ 1 year, HbA1c 7-9.5% in the last six months, were not on insulin and were using < 4 anti-hyperglycemic medications. 21 clinicians and 48 patients were randomly assigned to using the decision aid and 19 clinicians and 37 patients to usual care. Immediately post visit, patients and clinicians completed a questionnaire measuring outcomes related to the decision making process. At 6 months, we measured A1c and drug adherence using pharmacy records.
RESULTS: The decision aid promoted patient involvement in the decision making process: 96% (vs 84%) of patients who used the decision aid agreed with “my provider identified blood sugar control as a choice that I could participate in” (OR 3.71, 95% CI 0.72, 19.1); 92% (vs. 74%) of patients who used the decision aid agreed with “my provider asked about my expectations and fears regarding how my blood sugar is managed” (OR 7.97, 95% CI 1.5, 42.1); and 68% (vs. 58%) of participants would strongly recommend the decision aid to others facing a similar decision (OR 1.62, 95% CI 0.65, 4.02); 90% of clinicians want to have access to the decision aid for future diabetes visits. Video analysis showed that, compared to usual care, clinicians and patients using the diabetes cards more frequently discussed issues of importance to patients (such as the effect of medication on weight and the impact of medication on daily routine) and always discussed insulin.
CONCLUSION: A patient decision aid was acceptable in practice and enhanced patient-centered diabetes treatment intensification. The impact of this intervention on A1c and medication adherence awaits completion of 6-month follow-up (July 2008).
METHODS: We conducted a clustered randomized trial at 11 primary care and family medicine clinics in Southeastern Minnesota. Eligible patients had type 2 diabetes for ≥ 1 year, HbA1c 7-9.5% in the last six months, were not on insulin and were using < 4 anti-hyperglycemic medications. 21 clinicians and 48 patients were randomly assigned to using the decision aid and 19 clinicians and 37 patients to usual care. Immediately post visit, patients and clinicians completed a questionnaire measuring outcomes related to the decision making process. At 6 months, we measured A1c and drug adherence using pharmacy records.
RESULTS: The decision aid promoted patient involvement in the decision making process: 96% (vs 84%) of patients who used the decision aid agreed with “my provider identified blood sugar control as a choice that I could participate in” (OR 3.71, 95% CI 0.72, 19.1); 92% (vs. 74%) of patients who used the decision aid agreed with “my provider asked about my expectations and fears regarding how my blood sugar is managed” (OR 7.97, 95% CI 1.5, 42.1); and 68% (vs. 58%) of participants would strongly recommend the decision aid to others facing a similar decision (OR 1.62, 95% CI 0.65, 4.02); 90% of clinicians want to have access to the decision aid for future diabetes visits. Video analysis showed that, compared to usual care, clinicians and patients using the diabetes cards more frequently discussed issues of importance to patients (such as the effect of medication on weight and the impact of medication on daily routine) and always discussed insulin.
CONCLUSION: A patient decision aid was acceptable in practice and enhanced patient-centered diabetes treatment intensification. The impact of this intervention on A1c and medication adherence awaits completion of 6-month follow-up (July 2008).
See more of: Poster Session II
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)