A Demonstration Of Shared Decision Making In Primary Care Highlights Barriers To Adoption And Potential Remedies

TLDR

Recent health reform, including the Affordable Care Act, has encouraged delivery systems to adopt shared decision making, where patients and providers jointly make evidence‑based, value‑aligned health care choices. The study aimed to understand how primary care delivery systems can implement shared decision making by interviewing representatives from eight sites in a demonstration funded by the Informed Medical Decisions Foundation. The authors gathered data through interviews with site representatives and identified improvement strategies such as automatic triggers for decision aids and involving non‑physician team members in the decision‑making process. They found that barriers include overworked physicians, limited provider training, and clinical information systems that cannot prompt or track patients, concluding that substantial investments in training, information systems, and process reengineering are likely required for successful implementation.

Abstract

Recent developments in health reform related to the passage of the Affordable Care Act and ensuing regulations encourage delivery systems to engage in shared decision making, in which patients and providers together make health care decisions that are informed by medical evidence and tailored to the specific characteristics and values of the patient. To better understand how delivery systems can implement shared decision making, we interviewed representatives of eight primary care sites participating in a demonstration funded and coordinated by the Informed Medical Decisions Foundation. Barriers to shared decision making included overworked physicians, insufficient provider training, and clinical information systems incapable of prompting or tracking patients through the decision-making process. Methods to improve shared decision making included using automatic triggers for the distribution of decision aids and engaging team members other than physicians in the process. We conclude that substantial investments in provider training, information systems, and process reengineering may be necessary to implement shared decision making successfully.