Oct. 15, 2009 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. The results of this randomized trial are in September's issue of Archives of Internal Medicine.
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 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. While 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 and are a promising tool for better patient outcomes.
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.
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.
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- Rebecca J. Mullan; Victor M. Montori; Nilay D. Shah; Teresa J. H. Christianson; Sandra C. Bryant; Gordon H. Guyatt; Lilisbeth I. Perestelo-Perez; Robert J. Stroebel; Barbara P. Yawn; Victor Yapuncich; Maggie A. Breslin; Laurie Pencille; Steven A. Smith. The Diabetes Mellitus Medication Choice Decision Aid: A Randomized Trial. Archives of Internal Medicine, 2009; 169 (17): 1560 DOI: 10.1001/archinternmed.2009.293
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