实施电脑化病人决策辅助在门诊访问狼疮所需的时间。

Nathan W Carroll, Aizhan Karabukayeva, Larry R Hearld, Diane Kamen, Alfred H J Kim, Sonali Narain, Narender Annapureddy, Zineb Aouhab, Maureen McMahon, Vikas Majithia, Cathy Lee Ching, Winn Chatham, Jasvinder A Singh
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引用次数: 0

摘要

背景:患者决策辅助具有降低患者决策冲突和改善医患沟通的潜力。然而,决策辅助工具的采用一直很差,部分原因是将这些辅助工具纳入临床实践所需的时间尚未得到很好的了解。目的:估计风湿病诊所实施一个有效的决策辅助对狼疮患者所需的时间。方法:使用8个实施地点的队列,研究人员确定了管理决策辅助所需的活动。诊所内的现场协调员对每项活动的持续时间进行计时。为了估计观看决策辅助对医患互动时间长短的影响,对患者的就诊时间进行了计时,并将观看决策辅助的患者的就诊时间与三组对照患者的就诊时间进行了比较。结果:对决策辅助对患者就诊时间的影响的估计范围从每次就诊减少3分钟到每次就诊增加3.88分钟不等,6个估计中有5个表明决策辅助与缩短患者就诊有关。向患者介绍辅助决策的平均时间为4.12分钟(中位数为2分钟)。大多数诊所每周或每两周一次确定适合决策辅助的患者,平均耗时41.43分钟。结论:风湿病诊所对狼疮患者实施决策辅助所需的时间较低。我们的研究结果提出了一个问题,考虑到狼疮决策辅助给患者带来的好处(减少决策冲突和更好地选择用于治疗狼疮肾脏疾病的免疫抑制药物),为什么决策辅助在临床实践中使用率低。需要更多的研究来确定采用决策辅助的障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Time required to implement a computerized patient decision aid for lupus in outpatient visits.

Background: Patient decision aids have the potential to lower decision conflict for patients and to improve patient-physician communication. However, uptake of decision aids has been poor, in part because the time required to incorporate these into clinical practice is not well understood.

Objective: To estimate the time required for a rheumatology clinic to implement a validated decision aid for patients with lupus.

Methods: Using a cohort of eight implementation sites, study investigators identified the activities required to administer a decision aid. Site coordinators embedded within the clinics timed the duration of each activity. To estimate the effect of viewing the decision aid on the length of the physician-patient interaction, patient visits were timed and the length of visits for patients who viewed the decision aid were compared with visit lengths for three groups of control patients.

Results: Estimates of the effect of the decision aid on patient visit lengths ranged from a reduction of 3 min per visit to an increase of 3.88 min per visit, with five out of six estimates suggesting the decision aid is associated with shorter patient visits. Introducing the decision aid to patients took a mean of 4.12 min (median of 2 min). Identifying patients eligible for the decision aid was a weekly or bi-weekly process for most clinics and took an average of 41.43 min.

Conclusion: The time required for a rheumatology clinic to implement the decision aid for patients with lupus is low. Our results raise questions about why decision aid take up is low among clinical practices, given the benefits the lupus decision aid offers to patients (reduced decisional conflict and better-informed choice of immunosuppressive medications used for the treatment of lupus kidney disease). More research is needed to identify barriers to decision aid adoption.

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