scholarly journals Title: Playing Telephone: Understanding the state of medication decision making in growing healthcare teams in the time of electronic health records (Preprint)

2018 ◽  
Author(s):  
Kathryn Mercer ◽  
Catherine Burns ◽  
Lisa Guirguis ◽  
Jessie Chin ◽  
Maman Joyce Dogba ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Primary Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

BACKGROUND Primary care needs to be patient-centred, integrated and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, there is increasing attention on how and when medication-related decisions should be coordinated across multi-disciplinary care teams. Improved knowledge on how integrated EHRs can support interprofessional shared decision-making for medication therapy management is necessary to continue to improve patient care. OBJECTIVE This objective of this study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of electronic health records. METHODS This study is part of a broader cross-Canada study between patients and health care providers around how health-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Semi-structured interviews were conducted with physician and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. RESULTS Data was collected at 19 pharmacies and 9 medical clinics and we identified six main themes from 34 health care professionals. Interprofessional Shared Decision Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care further compounded by electronic health records not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician/Pharmacist Relationship which was often predicated by co-location. CONCLUSIONS When managing medications, there was limited communication and collaboration between primary care providers and pharmacists. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management, so that pharmacists and physicians move beyond task-based work toward a collaborative approach CLINICALTRIAL n/a

scholarly journals Association between Electronic Health Records and Health Care Utilization

2015 ◽  
Vol 06 (01) ◽  
pp. 42-55 ◽  
Author(s):  
A. Edwards ◽  
L.M. Kern ◽  
R. Kaushal ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Records ◽  
Health Care Utilization ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

SummaryBackground: The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited.Objective: To determine any association between EHRs and health care utilization.Methods: We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multi-provider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics.Results: Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions.Conclusions: Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.Citation: Kaushal R, Edwards A, Kern LM, with the HITEC Investigators. Association between electronic health records and health care utilization. Appl Clin Inf 2015; 6: 42–55http://dx.doi.org/10.4338/ACI-2014-10-RA-0089

The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

2018 ◽  
Vol 38 (8) ◽  
pp. 1040-1045 ◽  
Author(s):  
Alyce Mei-Shiuan Kuo ◽  
Berry Thavalathil ◽  
Glyn Elwyn ◽  
Zsuzsanna Nemeth ◽  
Stuti Dang
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Health Records ◽  
Look Ahead ◽  
The Face ◽  
Electronic Health ◽  
The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

scholarly journals A Model to Support Shared Decision Making in Electronic Health Records Systems

2014 ◽  
Vol 34 (8) ◽  
pp. 987-995 ◽  
Author(s):  
Leslie Lenert ◽  
Robert Dunlea ◽  
Guilherme Del Fiol ◽  
Leslie Kelly Hall
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Health Records ◽  
Electronic Health

scholarly journals ENHANCING COMMUNICATION AND SHARED DECISION MAKING VIA ELECTRONIC HEALTH RECORDS

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 595-595
Author(s):  
S. Dang ◽  
B. Thavalathil ◽  
D. Ruiz ◽  
C. Gomez-Orozco ◽  
P. Caralis ◽  
...  
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Health Records ◽  
Electronic Health

scholarly journals Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population

2021 ◽  
Vol 12 ◽  
Author(s):  
Elizabeth B. Matthews ◽  
Margot Savoy ◽  
Anuradha Paranjape ◽  
Diana Washington ◽  
Treanna Hackney ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Population ◽  
Primary Care Providers ◽  
Safety Net ◽  
Depression Treatment ◽  
Shared Decision ◽  
Care Providers ◽  
Depression Care

Objectives: Although depression is a significant public health issue, many individuals experiencing depressive symptoms are not effectively linked to treatment by their primary care provider, with underserved populations have disproportionately lower rates of engagement in depression care. Shared decision making (SDM) is an evidence-based health communication framework that can improve collaboration and optimize treatment for patients, but there is much unknown about how to translate SDM into primary care depression treatment among underserved communities. This study seeks to explore patients' experiences of SDM, and articulate communication and decision-making preferences among an underserved patient population receiving depression treatment in an urban, safety net primary care clinic.Methods: Twenty-seven patients with a depressive disorder completed a brief, quantitative survey and an in-depth semi-structured interview. Surveys measured patient demographics and their subjective experience of SDM. Qualitative interview probed for patients' communication preferences, including ideal decision-making processes around depression care. Interviews were transcribed verbatim and analyzed using thematic analysis. Univariate statistics report quantitative findings.Results: Overall qualitative and quantitative findings indicate high levels of SDM. Stigma related to depression negatively affected patients' initial attitude toward seeking treatment, and underscored the importance of patient-provider rapport. In terms of communication and decision-making preferences, patients preferred collaboration with doctors during the information sharing process, but desired control over the final, decisional outcome. Trust between patients and providers emerged as a critical precondition to effective SDM. Respondents highlighted several provider behaviors that helped facilitated such an optimal environment for SDM to occur.Conclusion: Underserved patients with depression preferred taking an active role in their depression care, but looked for providers as partner in this process. Due to the stigma of depression, effective SDM first requires primary care providers to ensure that they have created a safe and trusting environment where patients are able to discuss their depression openly.

scholarly journals Real-world Drivers Behind Communication, Medication Adherence, and Shared Decision Making In Minority Adults with Asthma

2020 ◽  
Vol 11 ◽  
pp. 215013272096780
Author(s):  
Allison A. Norful ◽  
Ani Bilazarian ◽  
Annie Chung ◽  
Maureen George
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Low Income ◽  
Primary Care Providers ◽  
Future Research ◽  
Shared Decision ◽  
Care Providers ◽  
Uncontrolled Asthma ◽  
Black Adults

Background: Inhaled corticosteroids (ICS) are the foundation of asthma management. However, ICS non-adherence is common. Black adults have lower ICS adherence than white adults, which likely contributes, in part, to the asthma disparities that Black adults experience. Objective: To explore how Black adults with uncontrolled asthma and their primary care providers communicated about ICS non-adherence and used shared decision-making to identify strategies to increase ICS use. Design: Eighty routine clinical visits for uncontrolled asthma were audio recorded and inductively analyzed using methods adapted from grounded theory methodology. Participants: Study participants included 80 Black adults (83% female) largely low-income (83% Medicaid) and their 10 primary care providers. The study settings were 2 Federally Qualified Health Centers. Key Results: Three overarching themes were identified: (1) ICS misuse and lack of knowledge; (2) external influences informed personal misconceptions about ICS; and (3) patient-provider communication to individualize plan of care. Conclusions: Reasons for ICS non-adherence in Black adults with uncontrolled asthma offer potential targets for interventions that facilitate enhanced adherence. Future research should include PCP training on strategies that support patient-centered care, such as communication, shared decision-making and patient engagement.

scholarly journals Smoking cessation and shared decision‐making practices about lung cancer screening among primary care providers

2021 ◽  
Author(s):  
Maria A. Lopez‐Olivo ◽  
Jennifer A. Minnix ◽  
James G. Fox ◽  
Shawn P. E. Nishi ◽  
Lisa M. Lowenstein ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Lung Cancer Screening ◽  
Primary Care Providers ◽  
Shared Decision ◽  
Care Providers
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