Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial

Ludman, Evette; Katon, Wayne; Bush, Terry; Rutter, Carolyn M.; Lin, Elizabeth; Simon, Gregory E.; Korff, Michael Von; Walker, Edward A.

doi:10.1017/s003329170300816x

Cited by 129 publications

(91 citation statements)

References 19 publications

(26 reference statements)

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“…There is a paucity of strong evidence from appropriately controlled trials that supports the inference from observational studies that SDM regarding treatment of a chronic disease (in which self-management is essential) actually results in patients accepting and adhering to the regimen and improves both treatment adherence and disease outcomes (16,17). Although a recent review of SDM by Joosten and colleagues (18) identified 11 randomized controlled trials that met at least one of Charles and colleagues' criteria, none concerned asthma, and nearly half involved a one-time treatment decision, rather than decisions typical of chronic disease management.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

Wilson

Strub

Buist

et al. 2010

Am J Respir Crit Care Med

576

461

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Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/ preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P , 0.0001) and long-acting b-agonist adherence (CMA, 0.51 vs. 0.40; P 5 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P , 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P 5 0.03) and long-acting b-agonist adherence (CMA, 0.51 vs. 0.41; P 5 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P 5 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. Conclusions: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. Clinical trials registered with www.clinicaltrials.gov (NCT00217945 and NCT00149526).

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Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

Wilson

Strub

Buist

et al. 2010

Am J Respir Crit Care Med

576

461

View full text Add to dashboard Cite

show abstract

“…Research studies have examined shared decision-making (SDM) for a variety of illnesses and disabilities, including treatment decisions related to cancer 51 , mental illness 52 , and substance abuse. 53 Results have demonstrated that SDM leads to enhanced patient knowledge and patient satisfaction with treatment choices (Clinical Scenario 4).…”

Section: Shared Decision-making To Optimize Medica-tion Usementioning

confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decisionmaking for clinicians interested in providing patientcentered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of nonadherence to medications for chronic conditions. A dherence to medications is often suboptimal-up to 50 % of patients do not take their prescribed medication as recommended. 1-4 Medication non-adherence is associated with adverse health outcomes as well as negative social and economic consequences. [5][6][7] The problem of medication nonadherence is often multifaceted and multifactorial; in general, most conceptual models of medication non-adherence take an ecological perspective, and include patient factors (e.g., literacy, cognitive function), provider factors (e.g., complex regimens), social/community factors (e.g., access to providers and pharmacy), health care factors (e.g., interaction with healthcare system, trust, prior authorization, fragmentation), and policy implications (e.g., coverage of medication). 8-10 Thus, to be effective, interventions designed to improve appropriate medication use must adopt a comprehensive approach, often combining numerous proven strategies. Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.Evidence increasingly demonstrates that adopting a personcentered approach for medication use that incorporates patient beliefs, preferences, goals, and barriers to medication-taking (e.g., cost, technological ability, concerns about medication prescribing and use) leads to better clinical outcomes. 17,18 Clinicians are in a key position to elicit this information from patients and to incorporate it into medication-related decisions, thereby improving medication adherence rates. Person-centered care focuses on providing patients with greater choice, recognizing their roles as consumers of health care who know best their own beliefs and preferences. This care is meant to encourage value concordance-in this case, the match between the treatment that is selected and the treatment that i...

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“…These decision tools can include interactive balance scales that list the pros and cons of a decision, allowing patients to attach their own values to each outcome [49], and personal testimonials to depict how individuals made decisions consistent with their values [50], and can provide quantitative estimates of risks, benefits, and harm that can be tailored to the individual to help patients identify preferences [51,52]. When clinicians collaborate with patients, engage in values clarification, and deliberate with patients, this allows patients to process information and apply knowledge; these processes can lead to greater satisfaction and trust, and even bolster treatment adherence in some contexts [7,[53][54][55][56][57]. Explicit values clarification can help clinicians and patients better understand each other's perspectives on decision and options.…”

Section: The Process Of Shared Decision Making In Oncology Practicementioning

confidence: 99%

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

2012

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Learning Objectives After completing this course, the reader will be able to: Outline the five steps that comprise shared decision making. Identify specific tactics that can be used to engage a patient in a shared decision making process. This article is available for continuing medical education credit at http://CME.TheOncologist.com Background. There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference‐sensitive decisions by incorporating patient preferences into decision discussions. Methods. This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient‐centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference‐sensitive decisions in which SDM can enhance the clinical encounter. Results. Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision‐making process. Conclusion. Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.

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Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial

Cited by 129 publications

References 19 publications

Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

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