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Perestelo-Perez L, Rivero-Santana A, Alvarez-Perez Y, Duarte-Díaz A, Ramos-García V, Torres-Castaño A, Abt-Sacks A, Toledo-Chavarri A, Alonso-Coello P, Orrego C, Serrano-Aguilar P. Shared decision-making in Spain in 2022: An updated revision of the current situation. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:122-128. [PMID: 35624010 DOI: 10.1016/j.zefq.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
In Spain, there is not a national strategy to promote shared decision making (SDM) in clinical practice, and it is still not a requisite for improving the quality of health services, in either the legal norms or professionals' educational curricula. However, several national strategies in specific health areas increasingly include the principles of person centred care (PCC) and SDM into their objectives, promoting patients' empowerment and activation. Furthermore, several institutions continue to develop Patient Decision Aids (PtDAs) and other resources to facilitate patients' involvement in their own care; training programs for professionals; links between PtDAs and clinical practice guidelines; as well as interventional studies assessing the impact of PCC and SDM interventions in clinical practice. Initiatives to involve patients in health research design and health technology assessment are also being developed. We describe an update of the current state of research, policy and implementation of SDM after five years of substantial advances in Spain. Many challenges remain regarding national and regional policies on PCC and SDM, implementation of SDM in real practice and educational curricula, development of quality indicators and evaluation procedures.
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Affiliation(s)
- Lilisbeth Perestelo-Perez
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain.
| | - Amado Rivero-Santana
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Yolanda Alvarez-Perez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Andrea Duarte-Díaz
- Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Vanesa Ramos-García
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Alezandra Torres-Castaño
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Analía Abt-Sacks
- Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Ana Toledo-Chavarri
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain; Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Carola Orrego
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Fundació Avedis Donavedian, Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain; Network of Agencies for Assessing National Health System Technologies and Performance (RedETS), Tenerife, Spain
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Hurley VB. Are patients really getting what they want? The routine implementation of decision aids for patients with hip or knee osteoarthritis in the high value healthcare collaborative and alignment between patient treatment choice and receipt. J Eval Clin Pract 2021; 27:1207-1215. [PMID: 33829617 DOI: 10.1111/jep.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Alignment between patients' treatment choices and treatments received is acknowledged as an important outcome of shared decision-making (SDM), yet recent research suggests that patients' choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient-expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrated decision aids intended to support SDM into routine clinical practice. METHOD This retrospective cohort study examines data from adult (≥18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopaedic consultations within HVHC systems between 2012 and 2015. Multivariable logistic regression explored the association between patient-level characteristics with the odds of treatment choice-receipt alignment. RESULTS The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with Caucasian patients (OR = 0.52, P < .05). Medicare- or Medicaid-insured knee patients had 49% and 59% lower odds (respectively) of receiving choice-aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, P < .01) or hip (OR = 0.75, P < .05) osteoarthritis at earlier decision-making stages had lower odds of receiving treatments congruent with their choices. CONCLUSION This work elucidates the odds of treatment choice-aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision-making stages.
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Affiliation(s)
- Vanessa B Hurley
- Health Systems Administration, Georgetown University, Washington, District of Columbia, USA
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