Article type
Year
Abstract
Background: One of the challenges for improving quality in heath care is to bring the separate worlds of evidence-based medicine and patient-centered medicine together [1].The Ottawa Decision Support Framework offers a structured approach to shared decision making that focuses on the best available evidences as well as the values of patients.
Objectives: To identify the barriers to and incentives for implementing the Ottawa Decision Support Framework in primary care practices.
Methods: The research was carried out throughout the teaching, health-care and research networks of the Department of Family Medicine of Laval University represented by Family Medicine Units (FMU). The study was a before-after design without control group that included a 1.5 hrs interactive workshop which introduced the Ottawa Decision Support Framework as well as the tools that accompany it. This workshop was also designed to include a group discussion. Participants (i.e. clinical teachers in family medicine, residents and other health care providers) were asked about: 1) the type of difficult decisions that their patients face, 2) the barriers to and, 3) the incentives for implementing the Ottawa Decision Support Framework in their own primary care practices. Each workshop was under the responsibility of one trainer and one co-trainer. A trained anthropologist acted as a non-participant observer. The trainer kept a personal log book. Participants completed an evaluation form at the end of each workshop. A content analysis of these three sources of data was performed by two independent assessors.
Preliminary results: Between November 20th 2003 and March 10th 2004, 64 clinical teachers, 50 residents and 4 other health care providers participated in one of the 13 workshops. The size of the groups varied from 4 to 16 participants. Participants reported that the most frequent types of difficult decisions that their patients face were: uptake of medication for chronic asymptomatic diseases (i.e. hypertension, dyslipidemia), surgical procedures, screening and diagnosis tests and resuscitation orders. Barriers to implementing the Ottawa Decision Support Framework were: lack of time, difficulty in accessing evidence at the point of care, not being convinced that patients want to participate in making decision and not being comfortable in asking patient if they want to participate in making decision. Incentives for implementing the Ottawa Decision Support Framework were among others: ability for bridging evidence-based medicine and patient-centered medicine, structured process and easy-to-use tools.
Conclusion: The transfer of a process that structures shared decision making to primary care practices has the potential to improve the quality of the decision making process during consultations with health practitioners However, barriers to and incentives for implementing the Ottawa Decision Support Framework will need to be taken into consideration.
References: 1. Bensing J. Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. Patient Educ Couns. Jan 2000;39(1):17-25
Objectives: To identify the barriers to and incentives for implementing the Ottawa Decision Support Framework in primary care practices.
Methods: The research was carried out throughout the teaching, health-care and research networks of the Department of Family Medicine of Laval University represented by Family Medicine Units (FMU). The study was a before-after design without control group that included a 1.5 hrs interactive workshop which introduced the Ottawa Decision Support Framework as well as the tools that accompany it. This workshop was also designed to include a group discussion. Participants (i.e. clinical teachers in family medicine, residents and other health care providers) were asked about: 1) the type of difficult decisions that their patients face, 2) the barriers to and, 3) the incentives for implementing the Ottawa Decision Support Framework in their own primary care practices. Each workshop was under the responsibility of one trainer and one co-trainer. A trained anthropologist acted as a non-participant observer. The trainer kept a personal log book. Participants completed an evaluation form at the end of each workshop. A content analysis of these three sources of data was performed by two independent assessors.
Preliminary results: Between November 20th 2003 and March 10th 2004, 64 clinical teachers, 50 residents and 4 other health care providers participated in one of the 13 workshops. The size of the groups varied from 4 to 16 participants. Participants reported that the most frequent types of difficult decisions that their patients face were: uptake of medication for chronic asymptomatic diseases (i.e. hypertension, dyslipidemia), surgical procedures, screening and diagnosis tests and resuscitation orders. Barriers to implementing the Ottawa Decision Support Framework were: lack of time, difficulty in accessing evidence at the point of care, not being convinced that patients want to participate in making decision and not being comfortable in asking patient if they want to participate in making decision. Incentives for implementing the Ottawa Decision Support Framework were among others: ability for bridging evidence-based medicine and patient-centered medicine, structured process and easy-to-use tools.
Conclusion: The transfer of a process that structures shared decision making to primary care practices has the potential to improve the quality of the decision making process during consultations with health practitioners However, barriers to and incentives for implementing the Ottawa Decision Support Framework will need to be taken into consideration.
References: 1. Bensing J. Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. Patient Educ Couns. Jan 2000;39(1):17-25