Barriers and facilitators to routine distribution of patient decision support interventions: a preliminary study in community-based primary care settings.
BACKGROUND
A growing body of literature documents the value of decision support interventions (DESIs) in facilitating patient participation in preference sensitive decision making, but little is known about their implementation in routine care.


OBJECTIVE
This study explored barriers and facilitators to prescribing DESIs in primary care.


METHODS
Four community-based primary care practices across Los Angeles County serving diverse low and middle income populations participated.


METHODS
The first phase focused on implementing DESI prescribing into routine care. Weekly academic detailing visits served to identify barriers to DESI prescribing, generate ethnographic field notes and record DESI prescriptions. The second phase explored the impact of a financial incentive on DESI prescribing. At the project's conclusion, each physician completed an in-depth interview.


RESULTS
The four practices prescribed an average of 6.5 DESIs a month (range 3.6-9.2) during Phase I. The financial incentive increased DESI prescribing by 71% to 11.1 per month (range 3.5-21.4). The estimated percentages of patients who viewed the DESI were 37.9 and 43.9% during Phases I and II, respectively. Qualitative data suggest that physician buy-in with the project goal was crucial to DESI distribution success. Competing demands and time pressures were persistent barriers. The effects of the financial incentive were mixed.


CONCLUSIONS
This study confirmed the importance of physician engagement when implementing DESIs and found mixed effects for providing financial incentives. The relatively low rate of DESI viewing suggests further research on increasing patient uptake of these interventions in routine practice is necessary.
Staff Research Assistant II, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA), Los Angeles, CAAssistant Research AnthropologistResearch AssistantAssociate Investigator, Palo Alto Medical Foundation Research Institute, Palo Alto, CAAssociate Professor of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
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Suepattra G
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D003153:Community Health Services; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005194:Family Practice; D005260:Female; D006801:Humans; D007388:Internal Medicine; D015141:Los Angeles; D008297:Male; D010358:Patient Participation; D010817:Physician-Patient Relations; D036301:Qualitative Research