INTEGRATING MENTAL HEALTH PATIENT DECISION AIDS INTO PRIMARY CARE PRACTICE

Purpose:

Decision aids (DA) have been shown to increase patients’ knowledge and involvement in treatment decisions, and reduce decisional conflict in randomized controlled trials. However, less is known about how to incorporate these tools in routine care. The aim of this study was to implement patient decision aids for mental health conditions in routine primary care practice.

Method:

We worked with three primary care practices affiliated with an academic health center. These practices were undergoing a hospital-wide effort to improve depression screening and behavioral health integration in primary care. We developed an order sheet with a description of three mental health video/booklet DAs addressing depression, anxiety, and insomnia. Practice staff gave the order sheet to all patients scheduled for preventive care visits at the time of arrival. Patients reviewed the sheet, checked off the program(s) of interest, and returned the sheet to the medical assistant. The medical assistant placed an order for the appropriate decision aid in the electronic medical record. We tracked the number of patient orders for these programs and compared that with orders placed in the four months prior to launching the new process. We also elicited feedback from the staff and clinicians at each site about their experience with the new process.

Result:

From August-November 2014, the four months prior to the study period, 2 depression, 1 anxiety, and 0 insomnia programs were ordered by clinicians at these practices. The new process was launched in December and from December 2014-March 2015, 134 depression, 193 anxiety, and 212 insomnia programs were ordered by patients across these three practices. The staff reported that it was easy to incorporate the order sheets into their workflow. Many of the staff members involved also commented on how patients have expressed their enthusiasm on being offered these resources.  The clinicians were pleased that their patients were receiving high quality materials.   

Conclusion:

There was a significant interest from patients in these practices for mental health focused decision aids. A clinician-driven approach to disseminating DAs greatly underestimated patients’ desire for information and support. Further study is ongoing to determine the impact of these programs on patient knowledge and decision making about mental health conditions.