A 12-week, facilitator-led shared decision-making (SDM) intervention was associated with a greater proportion of patients with asthma reporting equal treatment-related decision making with their provider compared with practices engaged in a traditional lunch-and-learn SDM approach, according to a study published in the Journal of Asthma.
Researchers randomly assigned 30 primary care practices across North Carolina that had ≥75 Medicaid patients with asthma who were >2 years old to a facilitator-led approach to implementing SDM (n=10), a 1-hour lunch-and-learn SDM training session (n=10), or a control group with no active intervention (n=10). A facilitator-led SDM intervention was a 12-week program led by trained facilitators from the research team who provided 1-hour-long sessions at the practice, with the goal of tailoring SDM to the practice’s culture.
The lunch-and-learn sessions involved 1-hour presentations each year for >2 years that discussed a general overview of the SDM toolkit for the care of patients with asthma. In the facilitator-led and traditional lunch-and-learn sessions, the primary outcome of interest was the perceptions of SDM, as assessed by questionnaire. Asthma-related emergency department visits, hospitalizations, and/or oral steroid prescription orders were collected as secondary outcomes.
A total of 705 and 523 surveys were collected from facilitator-led sites and lunch-and-learn sites, respectively. Facilitator-led sites had a higher percentage of patients who reported equal participation with their provider in making treatment decisions vs the lunch-and-learn sites (74.9% vs 66.3%, respectively; P =.001). No difference was found between the facilitator-led vs lunch-and-learn sites compared with controls in terms of emergency department visits (odds ratio [OR], 0.77 [95% CI, 0.57-1.04] vs OR, 0.83 [95% CI, 0.66-1.07]), number of hospitalizations (OR, 1.30 [95% CI, 0.59-2.89] vs OR, 1.40 [95% CI, 0.68-3.06]), or oral steroids (OR, 0.95 [95% CI, 0.79-1.15] vs OR, 1.03 [95% CI, 0.81-1.06]).
Limitations of the study include the lack of data on patients’ existing medications prescribed and the reliance on self-reports for the primary outcome, as well as data from only Medicaid patients.
Results of this small study “offer support for the use of structured approaches such as facilitator-led dissemination of complex interventions into primary care practices.”
Ludden T, Shade L, Reeves K, et al. Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management [published online September 25, 2018]. J Asthma. doi:10.1080/02770903.2018.1514630