Shared decision making challenging for PCPs

Inadequate clinical information systems that lacked the ability to identify which patients should receive decision aids or the ability to capture whether patients' views were considered in subsequent care are some of the biggest challenges facing primary care physicians seeking to implement shared decision making. The results of an eight-site demonstration was published in the February issue of Health Affairs.

The demonstration project was launched in July 2009 and led by the Boston-based Informed Medical Decisions Foundation. The project supported and followed early adopters as they planned and implemented decision aids geared to improving patient engagement. The study was authored by researchers from the foundation and RAND, and based on interviews with demonstration participants.

“No participating site reported having an information system that included tools for tracking whether patients actually received care concordant with their decisions,” the authors said in the study.

Only 10 to 30 percent of patients facing a medical decision actually received a decision aid when physicians chose the most appropriate patients for the aid. Lack of provider training hindered shared decisionmaking efforts, the study found, and many physicians said they were already effectively engaging patients in their care, despite evidence to the contrary.

Despite those challenges, two factors consistently eased implementation: automatic triggers for decision aid distribution and participation by non-physician team members.

“Given the difficulty of implementing shared decision making in primary care, accountable care organizations recognized by Medicare may fail to meaningfully engage patients and change patterns of care in their initial attempts to satisfy Medicare's final rule requirements,” the authors wrote in the study. “To meet this challenge, we recommend that such organizations carefully plan their implementation of shared decision making and make substantial long-term investments in information systems, provider training and process reengineering.”