初级保健中的共享决策：干预措施在 OPTIMAL 研究中的过程评估，一项集群随机试验。

Shared decision making in primary care: Process evaluation of the intervention in the OPTIMAL study, a cluster randomised trial.

机构信息

Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.

Public Health and Primary Care/LUMC Campus The Hague, Leiden University Medical Center, The Hague, and Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands.

出版信息

Prim Care Diabetes. 2022 Jun;16(3):375-380. doi: 10.1016/j.pcd.2022.02.006. Epub 2022 Mar 18.

DOI:10.1016/j.pcd.2022.02.006

PMID:35314131

Abstract

AIMS

To analyse the performance of a Shared Decision Making (SDM) intervention, we assessed perceived and experienced SDM in General Practitioners (GPs) and patients with type 2 diabetes (T2DM).

METHODS

Cluster-Randomised Controlled Trial (cRCT) testing the effect of a decision aid. Opinions and experienced role regarding SDM were assessed in 72 patients and 18 GPs with the SDM-Q-9 (range 0-45) and Control Preferences Scale (CPS, 0-5), and observed SDM with the OPTION5 (0-20). SDM at baseline was compared to 24 months' follow-up using paired t-tests.

RESULTS

At baseline, perceived levels of SDM did not significantly differ between GPs and patients with T2DM (difference of 2.3, p = 0.24). At follow-up, mean patients' perceived level of SDM was 7.9 lower compared to baseline (p < 0.01), whereas GPs' opinions had not changed significantly. After both visits, mean CPS scores differed significantly between patients and GPs. OPTION5 scores ranged between 6 and 20.

CONCLUSION

Patients and GPs perceived similar baseline levels of SDM. Two years later, patients perceived less SDM, while GPs did not change their opinion. SDM was appropriate immediately after training, but perhaps GPs fell back in old habits over time. We recommend repeated SDM training.

摘要

目的

为了分析一项共享决策制定（SDM）干预措施的效果，我们评估了全科医生（GP）和 2 型糖尿病（T2DM）患者对 SDM 的感知和体验。

方法

采用聚类随机对照试验（cRCT）来测试决策辅助工具的效果。使用 SDM-Q-9（范围 0-45）和控制偏好量表（CPS，0-5）评估 72 名患者和 18 名 GP 的意见和体验 SDM 的角色，使用 OPTION5（0-20）观察 SDM。使用配对 t 检验比较基线和 24 个月随访时的 SDM。

结果

基线时，T2DM 患者和 GP 之间的 SDM 感知水平没有显著差异（差异为 2.3，p=0.24）。随访时，患者感知的 SDM 平均水平比基线时低 7.9（p<0.01），而 GP 的意见没有明显变化。在两次就诊后，患者和 GP 的 CPS 评分均有显著差异。OPTION5 评分范围在 6 到 20 之间。