Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations

• HIT Description: Decision support More info...
  
• Purpose of Study: Quantitatively dscribe the impact of three types of decision aids on duration and content of primary care consultation
  
• Years of study: 2003-2004
  
• Study Design: RCT
  
• Outcomes: Efficiency, utilization & costs
  

• Settings: UK Primary care practice
• Intervention: Compare the impact of 2 forms of computer-based decision aids (implicit and explicit version of DARTS II) versus paper-based guidelines on provide patient interactions regarding using warfarin vs. aspirin to reduce the risk of stroke in patients with atrial fibrillation.
• Evaluation Method: Consultations were video- recorded; content analysis used existing interaction analysis protocols for verbal behavior and ethological techniques for non-verbal behavior.
• Description: The implicit (concise) computerized patient decision aid involves individualized risk and benefit presentation and a section to support shared decision making. The explicit (extended) version also includes patient's elicited values for health and treatment states derived via standard-gamble and analyzed in a Markov decision analysis.
• Barriers: Patient difficulties in understanding the standard-gamble procedure led to that arm being discontinued. All the consultations in this study went longer than the time usually available in primary care. Thus, it is unlikely that either the paper or computerized decision aids could be easily incorporated into practices.
• Changes in efficiency and productivity: Median consultation times were: 21 minutes with written guidelines, 31 minutes with implicit computerized tool, and 44 minutes with explicit computerized tool. Consultations did NOT get shorter as the MD became more familiar with the technology. There was no group difference in actual treatment decisions.