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Abstract
BackgroundMyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams.ObjectiveAssess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics.MethodsWe conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups.ResultsOne thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors.ConclusionAn interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care.Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015.
Highlights
Competing patient–physician priorities in the context of conditions with evidence-based treatment guidelines present challenges in the provision of care for complex individuals with multiple comorbidities [1]
We identified two key strategies that clinicians used that facilitated use and completion of MyDiabetesPlan during the appointment: engaging the patient in their care and providing information
Challenges with integrating MyDiabetesPlan into clinical care Though MyDiabetesPlan was successfully integrated into the clinical appointment in most cases, we identified barriers to optimal integration
Summary
Competing patient–physician priorities in the context of conditions with evidence-based treatment guidelines present challenges in the provision of care for complex individuals with multiple comorbidities [1]. Shared decision-making (SDM) can help prioritize treatment options and has the potential to improve patient care [2]. SDM can be facilitated by the use of patient decision aids (PtDAs) [2, 3, 6] as they help frame the decision to be made. In the trials on diabetes decision-making that were included in this review, patients who used PtDAs were more likely to change their medication. Mullan et al found that a diabetes medication choice decision aid engaged patients in their decision-making, adherence and HbA1c did not improve [8]. MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabe‐ tes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams
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