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Clinicians
develop new decision aid tool to help Type 2
Diabetes Patients
Newswise — Mayo Clinic clinicians and
designers, along with colleagues from other
institutions, have developed and tested a
tool to involve patients more in their
diabetes treatment and medication choices.
The tool, a set of decision aid cards, could
help patients make decisions involving their
disease and perhaps lead to better outcomes.
Victor Montori, M.D., a Mayo Clinic
endocrinologist in Rochester, is co-author
of the study. He heads the Knowledge
Encounter Research Unit (KER) in the
Department of Medicine and is a member of
the Center for Innovation at Mayo Clinic in
Rochester.
You can watch Dr. Montori and study
coordinator Rebecca Mullan discuss the trial
on this video on YouTube:http://www.youtube.com/watch?v=60d0RmQtw6k.
The Trial
The trial was conducted at 11 primary care
and family medicine sites within Mayo Health
System and Olmsted Medical Center, all in
southeast Minnesota.
Twenty-one clinicians and eighty-five
patients participated in the trial with
thirty-seven patients receiving “usual care”
and forty-eight patients using the decision
aid cards.
Health care clinicians, consisting of
physicians, physician assistants and nurse
practitioners, were responsible for managing
diabetes in adult patients with medication
options.
The Diabetes Medication Choice decision aid
cards were used to help patients and their
clinician reach a decision regarding their
course of care.
The cards were created by an innovative team
of patients, clinicians, educators and
designers.
The tool consists of six cards that describe
the possible effects of various medication
choices on six outcomes: weight change, low
blood sugar, blood sugar, daily routine,
daily sugar testing and side effects.
Clinicians were randomized to either use the
decision aid cards (intervention) or discuss
medications as usually done (control). Data
was gathered from a self-administered
written survey completed by patients
immediately after the patient’s visit.
Compared with the control patients, those
who used the cards found them helpful and
felt they were more involved in making
decisions about their diabetes medication.
Both groups had near-perfect adherence to
their medication use, the cards were
effective in involving patients with type 2
diabetes in the decision making.
The cards, originally created as a list of
medication options, changed during their
design.
“The
cards morphed from [originally] being a set
of cards about medications with somewhat
unpronounceable names into a set of cards
about issues that might be important to
people with type 2 diabetes,” says Maggie
Breslin, a designer in the SPARC Design
Studio in the Mayo Clinic Center for
Innovation. SPARC stands for See, Plan, Act,
Refine, and Communicate and is the first
design studio to be integrated into a
medical practice setting, allowing the
designers/researchers to work directly with
patients in a care setting.
She says the cards provided a much easier
starting point for patients to better
communicate with their care providers.
You
can view Breslin discussing the cards on
YouTube at:http://www.youtube.com/watch?v=AMcCLhEZdC8.
The initial randomized trial of the Diabetes
Medication Choice decision aid cards was
inconclusive because both patient groups had
near-perfect adherence to their medication
use.
However, the Agency for Healthcare Research
and Quality (AHRQ) recently awarded a grant
to the team to further evaluate the efficacy
of these cards in rural primary care
practices in southeastern Minnesota.
Dr. Montori says, “We are going to see if
these same tools can impact the health of
patients with diabetes in rural communities
in southeastern Minnesota … to see if these
decision aids can in fact provide better
patient-centered care for patients with
diabetes.”
Other trial co-authors are: Sandra Bryant;
Laurie Pencille; Nilay Shah, Ph.D.; Steven
Smith, M.D.; Robert Stroebel, M.D.; and
Victor Yapuncich, M.D., all from Mayo
Clinic; Gordon Guyatt, M.D., McMaster
University, Hamilton, Ontario; Lilisbeth
Perestelo-Peres, Ph.D., Canary Islands
Health Service and CIBER en Epidemiologia y
Salud Publica, Tenerife, Spain; Barbara
Yawn, M.D., Olmsted Medical Center,
Rochester, Minn.; and the Department of
Family and Community Health, University of
Minnesota, Minneapolis.
The study was funded by an American Diabetes
Association grant.
About Mayo Clinic
Mayo Clinic is the first and largest
integrated, not-for-profit group practice in
the world. Doctors from every medical
specialty work together to care for
patients, joined by common systems and a
philosophy of “the needs of the patient come
first.” More than 3,300 physicians,
scientists and researchers and 46,000 allied
health staff work at Mayo Clinic, which has
sites in Rochester, Minn.; Jacksonville,
Fla.; and Scottsdale/Phoenix, Ariz.
Collectively, the three locations treat more
than half a million people each year. To
obtain the latest news releases from Mayo
Clinic, go to www.mayoclinic.org/news. For
information about research and education,
visit www.mayo.edu.
MayoClinic.com (www.mayoclinic.com)
is available as a resource for your health
stories.
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