Patient and provider perspectives on uptake of a shared decision making intervention for asthma in primary care practices

ABSTRACT

Objective: Poor outcomes and health disparities related to asthma result in part from difficulty disseminating new evidence such as shared decision making (SDM) into clinical practice. As part of a three-arm cluster randomized dissemination study, evaluation of the impact of different dissemination methods was studied. Here we evaluate themes from patient and provider focus groups to assess the impact of a facilitated, traditional dissemination approach, or no intervention, on patient and provider perspectives of asthma care. Methods: Using semi-structured questions, twenty-four pre- and post-intervention focus groups with patients and providers took place across primary care practices. Discussions were held in all three arms both before and after the time of intervention rollout. Audio recordings were transcribed and analyzed for themes. Results: Across all sites patients and providers discussed themes of communication, asthma self-management, barriers, education, and patient awareness. After the intervention, compared to traditional sites, facilitated practices were more likely to discuss themes related to SDM, such as patient-centered communication, patient-provider negotiation on treatment plan, planning, goal-setting, and solutions to barriers. Conclusions: Emergent themes allowed for further understanding of how the SDM implementation was perceived at the patient and provider level. The facilitated implementation was associated with higher adoption of the SDM intervention. These themes and supporting quotes add to knowledge of best practices associated with implementing an evidence-based SDM intervention for asthma into primary care and will inform researchers, practices, and providers as they work to improve adoption of evidence-based interventions into practice.

KEYWORDS:

• Shared decision making
• implementation
• primary care
• asthma
• randomized controlled trial
• qualitative research

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Acknowledgements

We gratefully acknowledge the analysis assistance of Chandler Gates and Sherry Bargoil. We extend our gratitude to all the participating practices, patients, and providers and members of the North Carolina Network Consortium and all PBRNs involved. Research reported in this publication was funded through a Patient‐Centered Outcomes Research Institute Award (CD-12-11-4276). The opinions in this publication are solely the responsibility of the authors and do not necessarily “represent the views of PCORI, its Board of Governors, or Methodology Committee.” This publication was supported by Grant Number UL1TR001111 from the National Center for Advancing Translational Sciences at the National Institutes of Health.