Filtering by
- All Subjects: decision making
- All Subjects: Education
Vasomotor symptoms (VMS) associated with menopause vary greatly, as do the multitude of available treatment options. It can be difficult for clinicians to manage these symptoms while balancing patient safety concerns and preferences. Shared decision-making (SDM) can assist both the provider and patient to navigate the various treatment options, minimizing gaps between their preferences.
To assess the effect of SDM in a nurse-led practice in the Southwest, two nurse practitioners (NP) were invited to use a menopausal decision aid (DA). Women aged 40 to 64 years experiencing VMS were invited to participate in the project. Following a visit with the NP in which the DA was used, patients completed a six question post-intervention survey based on both the Decisional Conflict Scale (DCS) and SDM-Q-9 surveys. Patients were also asked to complete a telephone interview about the process 1-2 weeks post-intervention. The NP completed a post-intervention survey based on the SDM-Q-Doc to assess clinician satisfaction with the SDM process. Eight patients (mean age, 47.9 years), presenting with a range of 2 to 6 perimenopausal symptoms participated in the project.
All patients (100%) strongly or completely agreed that the clinician precisely explained the advantages & disadvantages of treatment options, helped them understand all the information, reached an agreement on how to proceed with care, and were extremely satisfied or satisfied with their decision and making an informed choice. Both clinicians completely agreed they had come to an agreement on how to proceed, and completely or strongly agreed they helped the patient understand all information. There was a correlation between the use of SDM patient’s age, making an informed choice, and being satisfied with their decision. Incorporating a perimenopausal DA can enhance patient and clinician satisfaction with SDM to understand their treatment options and make an informed menopausal decision.
Methods: An academic detailing session was provided by the Florida Department of Health in Broward County to primary care providers (PCPs) at a private clinic in the Southeastern US. The Conceptual Model of Nursing and Population Health (CMNPH) and the Promoting Action on Research Implementation in Health Services Framework (PARIHS) were used as guides for project design and evidence-based practice implementation. There were five participants in the academic detailing session including: a physician, a physician assistant (PA), and three medical students. PCP PrEP knowledge, attitudes, and behaviors were measured using pre and post intervention surveys. PrEP prescription, HIV/Sexually Transmitted Infection (STI) screening, and HIV testing were measured using aggregate data queries for the time periods of four and eight weeks before and four and eight weeks after the educational intervention. No personal identifying information was obtained.
Results: Pre and post surveys were analyzed using Wilcoxon signed rank testing to examine differences between matched pairs of ordinal data. Significant PrEP screening and HIV/STI testing were analyzed pre and post intervention using paired t tests to compare pre and post intervention practices. Significant differences were found in the results (Z = 2.03, 1.84, and 1.83 respectively, p > 0.1) The academic detailing intervention significantly improved knowledge, attitudes, and behaviors of primary care providers and medical students regarding PrEP. The mean of active qualifying ICD 10 codes prior to the intervention versus post intervention were 5 (sd = 5.64) vs. 4.2 (sd = 4.87) respectively. No significant difference was found between active ICD 10 codes for patient visits before compared to after the intervention (t (9) = 1.12, p>.1).
Conclusions: This project found that academic detailing improved provider self-reported knowledge, attitudes, and behaviors regarding PrEP. However, self-reported survey scores were not correlated with changes in clinical practice based on ICD 10 codes. Additional clinical implications may include fostering clinical outreach and cooperation between the county health department and local primary care clinics. Further research is needed on the effects of PrEP academic detailing on clinical practice.