Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs.
Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs.
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DOI：
10.1016/j.mayocpiqo.2020.04.013
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发表时间：
2020-08-01
期刊：
影响因子：
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通讯作者：
Brito, Juan P
中科院分区：
文献类型：
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作者：
Espinoza Suarez, Nataly R;LaVecchia, Christina M;Brito, Juan P
目的：为了确定如何共享决策（SDM）的工具，在临床上遇到，提高成本作为一个问题的影响发生率的患者和临床医生之间的成本conversations.Patients和方法：随机选择的一组220个视频记录的临床遭遇进行了分析。视频是从八个实践为基础的随机临床试验和一个准随机临床试验（前和后）比较护理与不SDM工具。次要分析于2018年进行，来自2007年至2015年的试验。结果：大多数患者参与者为白色（85%），受过教育（38%完成大学学业），中年（平均年龄56岁）和女性（61%）。有105次使用SDM工具，115次没有使用SDM工具。与SDM工具的接触更可能包括一般费用对话（62% vs 36%，比值比[OR]：9.6; 95% CI：4至26）以及具体的药物费用对话（89% vs 51%，P= 0.01）。然而，使用SDM工具的临床医生在就诊过程中不太可能解决成本问题（37% vs 51%，P= 0.04）。与患者接触不到一个大学学位也与较高的发病率成本conversation.CONCLUSION：使用SDM工具，提高成本作为一个问题增加了成本对话的发生，但不太可能解决成本问题或提供潜在的解决方案，病人的成本问题。这一结果表明，协商期间使用的“可持续发展机制”工具可以引发成本对话，但不足以支持这些对话。
OBJECTIVE: To determine how shared decision-making (SDM) tools used during clinical encounters that raise cost as an issue impact the incidence of cost conversations between patients and clinicians.PATIENTS AND METHODS: A randomly selected set of 220 video recordings of clinical encounters were analyzed. Videos were obtained from eight practice-based randomized clinical trials and one quasi-randomized clinical trial (pre- and post-) comparing care with and without SDM tools. The secondary analysis took place in 2018 from trials ran between 2007 and2015.RESULTS: Most patient participants were white (85%), educated (38% completed college), middle-aged (mean age 56 years), and female (61%). There were 105 encounters with and 115 without the SDM tool. Encounters with SDM tools were more likely to include both general cost conversations (62% vs 36%, odds ratio [OR]: 9.6; 95% CI: 4 to 26) as well as conversations on medication costs specifically (89% vs 51%, P=.01). However, clinicians using SDM tools were less likely to address cost issues during the encounter (37% vs 51%, P=.04). Encounters with patients with less than a college degree were also associated with a higher incidence of cost conversations.CONCLUSION: Using SDM tools that raise cost as an issue increased the occurrence of cost conversations but was less likely to address cost issues or offer potential solutions to patients' cost concerns. This result suggests that SDM tools used during the consultation can trigger cost conversations but are insufficient to support them.