title: Implementing shared decision making in federally qualified health centers, a quasi-experimental design study: the Office-Guidelines Applied to Practice (Office-GAP) program.
abstract: Use of Shared Decision-Making (SDM) and Decision Aids (DAs) has been encouraged but is not regularly implemented in primary care. The Office-Guidelines Applied to Practice (Office-GAP) intervention is an application of a previous model revised to address guidelines based care for low-income populations with diabetes and coronary heart disease (CHD).
  
  
  
  To evaluate Office-GAP Program feasibility and preliminary efficacy on medication use, patient satisfaction with physician communication and confidence in decision in low-income population with diabetes and coronary heart disease (CHD) in a Federally Qualified Healthcare Center (FQHC).
  
  
  
  Ninety-five patients participated in an Office-GAP program. A quasi-experimental design study, over 6 months with 12-month follow-up. Office-GAP program integrates health literacy, communication skills education for patients and physicians, patient/physician decision support tools and SDM into routine care.
  
  
  
  1) Implementation rates of planned program elements 2) Patient satisfaction with communication and confidence in decision, and 3) Medication prescription rates. We used the GEE method for hierarchical logistic models, controlling for confounding.
  
  
  
  Feasibility of the Office-GAP program in the FQHC setting was established. We found significant increase in use of Aspirin/Plavix, statin and beta-blocker during follow-up compared to baseline: Aspirin OR 1.5 (95 % CI: 1.1, 2.2) at 3-months, 1.9 (1.3, 2.9) at 6-months, and 1.8 (1.2, 2.8) at 12-months. Statin OR 1.1 (1.0, 1.3) at 3-months and 1.5 (1.1, 2.2) at 12-months; beta-blocker 1.8 (1.1, 2.9) at 6-months and 12-months. Program elements were consistently used (≥ 98 % clinic attendance at training and tool used). Patient satisfaction with communication and confidence in decision increased.
  
  
  
  The use of Office-GAP program to teach SDM and use of DAs in real time was demonstrated to be feasible in FQHCs. It has the potential to improve satisfaction with physician communication and confidence in decisions and to improve medication use. The Office-GAP program is a brief, efficient platform for delivering patient and provider education in SDM and could serve as a model for implementing guideline based care for all chronic diseases in outpatient clinical settings. Further evaluation is needed to establish feasibility outside clinical study, reach, effectiveness and cost-effectiveness of this approach.
authors.affiliation: Department of Medicine, Michigan State University, East Lansing, USA. ade.olomu@hc.msu.edu.
authors.forename: Adesuwa
authors.identifier: 0000-0002-8244-9308
authors.initials: A
authors.lastname: Olomu
authors.affiliation: College of Arts and Letters, Michigan State University, East Lansing, USA.
authors.forename: William
authors.initials: W
authors.lastname: Hart-Davidson
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, USA.
authors.forename: Zhehui
authors.initials: Z
authors.lastname: Luo
authors.affiliation: Center for Ethics and Humanities in the Life Sciences and Department of Medicine, Michigan State University, East Lansing, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Kelly-Blake
authors.affiliation: Center for Ethics and Humanities in the Life Sciences and Department of Medicine, Michigan State University, East Lansing, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002318:Cardiovascular Diseases / Q000628:therapy; D003657:Decision Making; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D016730:Program Development; D019984:Quality Indicators, Health Care; D012107:Research Design
keywords: Federally qualified health center; Patient activation; Prevention of heart disease; Quality improvement; Shared decision-making