PMID- 22212453 OWN - NLM STAT- MEDLINE DCOM- 20141216 LR - 20211021 IS - 1369-7625 (Electronic) IS - 1369-6513 (Print) IS - 1369-6513 (Linking) VI - 17 IP - 3 DP - 2014 Jun TI - Barriers and facilitators to routine distribution of patient decision support interventions: a preliminary study in community-based primary care settings. PG - 353-64 LID - 10.1111/j.1369-7625.2011.00760.x [doi] AB - BACKGROUND: A growing body of literature documents the value of decision support interventions (DESIs) in facilitating patient participation in preference sensitive decision making, but little is known about their implementation in routine care. OBJECTIVE: This study explored barriers and facilitators to prescribing DESIs in primary care. SETTING AND PARTICIPANTS: Four community-based primary care practices across Los Angeles County serving diverse low and middle income populations participated. DESIGN: The first phase focused on implementing DESI prescribing into routine care. Weekly academic detailing visits served to identify barriers to DESI prescribing, generate ethnographic field notes and record DESI prescriptions. The second phase explored the impact of a financial incentive on DESI prescribing. At the project's conclusion, each physician completed an in-depth interview. RESULTS: The four practices prescribed an average of 6.5 DESIs a month (range 3.6-9.2) during Phase I. The financial incentive increased DESI prescribing by 71% to 11.1 per month (range 3.5-21.4). The estimated percentages of patients who viewed the DESI were 37.9 and 43.9% during Phases I and II, respectively. Qualitative data suggest that physician buy-in with the project goal was crucial to DESI distribution success. Competing demands and time pressures were persistent barriers. The effects of the financial incentive were mixed. CONCLUSIONS: This study confirmed the importance of physician engagement when implementing DESIs and found mixed effects for providing financial incentives. The relatively low rate of DESI viewing suggests further research on increasing patient uptake of these interventions in routine practice is necessary. CI - (c) 2011 John Wiley & Sons Ltd. FAU - Uy, Visith AU - Uy V AD - Staff Research Assistant II, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA), Los Angeles, CAAssistant Research AnthropologistResearch AssistantAssociate Investigator, Palo Alto Medical Foundation Research Institute, Palo Alto, CAAssociate Professor of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA), Los Angeles, CA, USA. FAU - May, Suepattra G AU - May SG FAU - Tietbohl, Caroline AU - Tietbohl C FAU - Frosch, Dominick L AU - Frosch DL LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120102 PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - *Community Health Services MH - Decision Support Systems, Clinical/*statistics & numerical data MH - Family Practice MH - Female MH - Humans MH - Internal Medicine MH - Los Angeles MH - Male MH - *Patient Participation MH - *Physician-Patient Relations MH - Qualitative Research PMC - PMC5060726 OTO - NOTNLM OT - community based research OT - decision support OT - shared decision making EDAT- 2012/01/04 06:00 MHDA- 2014/12/17 06:00 PMCR- 2014/06/01 CRDT- 2012/01/04 06:00 PHST- 2012/01/04 06:00 [entrez] PHST- 2012/01/04 06:00 [pubmed] PHST- 2014/12/17 06:00 [medline] PHST- 2014/06/01 00:00 [pmc-release] AID - HEX760 [pii] AID - 10.1111/j.1369-7625.2011.00760.x [doi] PST - ppublish SO - Health Expect. 2014 Jun;17(3):353-64. doi: 10.1111/j.1369-7625.2011.00760.x. Epub 2012 Jan 2.