Process for development and prototyping of decision aid.

<p>Process for development and prototyping of decision aid.</p

PCI Choice: early prototype of benefits page.

<p>Used with permission of Mayo Foundation for Medical Education and Research; Creative Commons License does not apply.</p

L'Auto-vélo : automobilisme, cyclisme, athlétisme, yachting, aérostation, escrime, hippisme / dir. Henri Desgranges

03 juillet 19341934/07/03 (A35,N12252)

Additional file 2: of Effective strategies for scaling up evidence-based practices in primary care: a systematic review

Search strategy in MEDLINE (Ovid), August 30, 2016. (DOCX 44 kb

Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II

<div><p>Purpose</p><p>Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient’s estimated risk of fracture using the FRAX calculator is unknown.</p><p>Methods</p><p>Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.</p><p>Results</p><p>We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01), improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively), had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001). Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer). There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07); medication adherence at 6 months was no different across arms.</p><p>Conclusion</p><p>Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.</p><p>Trial Registration</p><p>clinical trials.gov <a href="http://clinicaltrials.gov/show/NCT00949611" target="_blank">NCT00949611</a></p></div

Decision and adherence.

<p>¹Counts (%),Chi-square test p-value, unless noted otherwise</p><p>²Median (95% CI), Wilcoxon Rank Sum Test p-value</p><p>³Decision Aid is the reference of relative risk where ‘Start Bisphosphonates’ is being compared to the combination of ‘Do not start’ and ‘Undecided/Other’</p><p>⁴Fisher’s Exact Test p-value</p><p>Decision and adherence.</p

Patient knowledge and decisional conflict.

<p>¹Median (IQR), Wilcoxon rank sum test p-value</p><p>²Answered correctly (% Correct), Chi-square test p-value.</p><p>³Decision Aid is the reference for Relative Risk.</p><p>Patient knowledge and decisional conflict.</p

Patient and clinician characteristics.

<p>¹Values missing for patients</p><p>²Bias assessment of prescribing rates assessed for stratifying patients</p><p>³Number of encounters included in the study; SD = Standard deviation</p><p>Patient and clinician characteristics.</p

Additional file 2: of Effective strategies for scaling up evidence-based practices in primary care: a systematic review

Search strategy in MEDLINE (Ovid), August 30, 2016. (DOCX 44 kb

Additional file 5: of Effective strategies for scaling up evidence-based practices in primary care: a systematic review

Quality assessment of 14 included studies using the Effective Public Health Practice Project tool. (DOCX 14 kb