Top

Published in:

Open Access 01-12-2018 | Research article

Shared decision making and experiences of patients with long-term conditions: has anything changed?

Authors: Reem Kayyali, Shereen Nabhani Gebara, Iman Hesso, Gill Funnell, Minal Naik, Thuy Mason, Mohammed Ahsan Uddin, Noor Al-Yaseri, Umar Khayyam, Teebah Al-Haddad, Roshan Siva, John Chang

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services.

Methods

A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics.

Results

The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service.

Conclusion

Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals.

Available only for authorised users

Katusiime B, Corlett S, Reeve J, Krska J. Measuring medicine-related experiences from the patient perspective: a systematic review. Patient Relat Outcome Meas. 2016;7:157.CrossRefPubMedCentralPubMed

Raynor DK, Savage I, Knapp P, Henley J. We are the experts: people with asthma talk about their medicine information needs. Patient Educ Couns. 2004;53(2):167–74.CrossRefPubMed

Bellingham C. How to improve medicines management at the primary/secondary care interface. 2004; 272:210-http://www.pharmaceutical-journal.com/opinion/comment/how-to-improve-medicines-management-at-the-primary/secondary-care-interface/11091161.article. (Accessed 15 Jul 2017).

Himmel W, Kochen M, Sorns U, Hummers-Pradier E. Drug changes at the interface between primary and secondary care. Int J Clin Pharmacol Ther. 2004;42(2):103–9.CrossRefPubMed

Bullock S, Morecroft CW, Mullen R, Ewing AB. Hospital patient discharge process: an evaluation. Eur J Hosp Pharm. 2016. https://doi.org/10.1136/ejhpharm-2016-000928.CrossRefPubMedPubMedCentral

Care Quality Commission. National summary of the Outpatients department 2011 survey. 2011.

Chan FW, Wong FY, So WY, Kung K, Wong CK. How much do elders with chronic conditions know about their medications? BMC Geriatr. 2013;13(1):59.CrossRefPubMedCentralPubMed

Barnes N, Calverley PM, Kaplan A, Rabe KF. Chronic obstructive pulmonary disease and exacerbations: patient insights from the global hidden depths of COPD survey. BMC Pulm Med. 2013;13(1):54.CrossRefPubMedCentralPubMed

Hesso I, Gebara SN, Kayyali R. Impact of community pharmacists in COPD management: inhalation technique and medication adherence. Respir Med. 2016;118:22–30.CrossRefPubMed

10.

Kayyali R, Gebara SN, Hesso I, Siva R, Kaimakamis E, Vaes AW, et al. User profiling for coordinated and integrated care. IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI). IEEE. 2016;473–6.

11.

Rodgers RM, Gammie SM, Loo RL, Corlett SA, Krska J. Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England. Patient Prefer Adherence. 2016;10:1749.CrossRefPubMedCentralPubMed

12.

Pammett R, Jorgenson D. Eligibility requirements for community pharmacy medication review services in Canada. Can Pharm J. 2014;147(1):20–4.CrossRef

13.

De Simoni A, Mullis R, Clyne W, Blenkinsopp A. Medicines optimisation in primary care: can community pharmacies deliver? Br J Gen Pract. 2012;62(601):398–9.CrossRefPubMedCentralPubMed

14.

NICE. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. 2015: https://www.nice.org.uk/guidance/ng5/resources/medicines-optimisation-the-safe-and-effective-use-of-medicines-to-enable-the-best-possible-outcomes-pdf-51041805253. (Accessed 15 Jul 2017).

15.

Shay LA, Lafata JE. Understanding patient perceptions of shared decision making. Patient Educ Couns. 2014;96(3):295–301.CrossRefPubMedCentralPubMed

16.

Eliacin J, Salyers MP, Kukla M, Matthias MS. Patients’ understanding of shared decision-making in a mental health setting: the importance of the patient-provider relationship. Qual Health Res. 2015;25(5):668–78.CrossRefPubMed

17.

Mallinger JB, Griggs JJ, Shields CG. Patient-centered care and breast cancer survivors’ satisfaction with information. Patient Educ Couns. 2005;57(3):342–9.CrossRefPubMed

18.

Suhonen R, Välimäki M, Katajisto J, Leino-Kilpi H. Provision of individualised care improves hospital patient outcomes: an explanatory model using LISREL. Int J Nurs Stud. 2007;44(2):197–207.CrossRefPubMed

19.

Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Mak. 2015;(35, 1):114–31.CrossRefPubMedCentralPubMed

20.

Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med. 2010;8(5):410–7.CrossRefPubMedCentralPubMed

21.

Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566–77.CrossRefPubMed

22.

NICE. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. 2009: https://www.nice.org.uk/guidance/cg76/resources/medicines-adherence-involving-patients-in-decisions-about-prescribed-medicines-and-supporting-adherence-pdf-975631782085. (Accessed 10 Aug 2017).

23.

Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45.CrossRefPubMed

24.

Mason M. Sample size and saturation in PhD studies using Qualitative interviews. Forum qualitative Sozialforschung/Forum: qualitative social research; 2010;11(3).

25.

Wright S, Morecroft CW, Mullen R, Ewing AB. UK hospital patient discharge: the patient perspective. Eur J Hosp Pharm. 2017. https://doi.org/10.1136/ejhpharm-2016-001134.CrossRefPubMedPubMedCentral

26.

Kayyali R, Marques Gomes A, Mason T, Naik M. Patient perceptions of medication counselling from community pharmacies. PPIJ. 2016;4(2):00071.

27.

Scott AS, Baltzan MA, Dajczman E, Wolkove N. Patient knowledge in chronic obstructive pulmonary disease: back to basics. COPD: J Chron Obstruct Pulmon Dis. 2011;8(5):375–9.CrossRef

28.

Thakrar R, Alaparthi GK, Kumar SK, Vaishali K, Zulfeequer CP, Aanad R. Awareness in patients with COPD about the disease and pulmonary rehabilitation: a survey. Lung India. 2014;31(2):134–8.CrossRefPubMedCentralPubMed

29.

Sharma MK, Kumar A, Venkateshan M. Effectiveness of self-instructional module on knowledge of self-care management of chronic obstructive pulmonary disease among patients with chronic obstructive pulmonary disease. IJRMS. 2016;4(5):1604–8.

30.

Barr RG, Celli BR, Martinez FJ, Ries AL, Rennard SI, Reilly JJ, et al. Physician and patient perceptions in COPD: the COPD resource network needs assessment survey. Am J Med. 2005;118(12):1415.9–1415.e17.CrossRef

31.

NHS England. Putting Patients First: The NHS England business plan for 2013/14–2015/16. 2013: https://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf. (Accessed 15 Jul 2017).

32.

Ford S, Schofield T, Hope T. Observing decision-making in the general practice consultation: who makes which decisions? Health Expect. 2006;9(2):130–7.CrossRefPubMedCentralPubMed

33.

Department of Health. The Patient's Charter. 1991.

34.

Farrell C. Patient and public involvement in health: the evidence for policy implementation. Department of Health 2004: http://webarchive.nationalarchives.gov.uk/20121107104340/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082334.pdf. (Accessed 15 Aug 2017).

35.

Exceutive N. Patient partnership: building a collaborative strategy. 1996.

36.

Department of Health. Liberating the NHS: No decision about me without me- Goverment response. 2012: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216980/Liberating-the-NHS-No-decision-about-me-without-me-Government-response.pdf. (Accessed 22 Aug 2017).

37.

Levinson W, Kao A, Kuby A, Thisted RA. Not all patients want to participate in decision making. J Gen Intern Med. 2005;20(6):531–5.CrossRefPubMedCentralPubMed

38.

Raynor D, Silcock J, Knapp P, Edmondson H. How do patients use medicine information leaflets in the UK? Int J Pharm Pract. 2007;15(3):209–18.CrossRef

39.

Hajizadeh N, Uhler LM, Pérez Figueroa RE. Understanding patients' and doctors' attitudes about shared decision making for advance care planning. Health Expect. 2015;18(6):2054–65.CrossRefPubMed

40.

Ford S, Schofield T, Hope T. Are patients’ decision-making preferences being met? Health Expect. 2003;6(1):72–80.CrossRefPubMedCentralPubMed

41.

Martin LR, Williams SL, Haskard KB, Dimatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(3):189–99.PubMedPubMedCentral

42.

Coulter A, Collins A. Making shared decision-making a reality. London: King’s Fund; 2011.

43.

Say R, Murtagh M, Thomson R. Patients’ preference for involvement in medical decision making: a narrative review. Patient Educ Couns. 2006;60(2):102–14.CrossRefPubMed

44.

Fisher M, Qureshi H, Hardyman W, Homewood J. Using qualitative research in systematic reviews: older people’s views of hospital discharge. London. England: Social Care Institute for Excellence; 2006.

45.

Street RL Jr, Gordon HS, Ward MM, Krupat E, Kravitz RL. Patient participation in medical consultations: why some patients are more involved than others. Med Care. 2005 Oct;43(10):960–9.CrossRefPubMed

46.

Pharmaceutical Services Negotiatting Committee (PSNC). PSNC Briefing 016/14: Advanced Services (MURs and the NMS). 2014:http://psnc.org.uk/wp-content/uploads/2014/09/PSNC-Briefing-016.14-Settlement-Advanced-Services-Sept-2014.pdf. (Accessed 15 May 2017).

47.

Smith J, Picton C, Dayan M. Now more than ever: why pharmacy needs to act. London: Royal Pharmaceutical Society; 2014.

48.

Carter P. Operational productivity and performance in English NHS acute hospitals: unwarranted variations. London: Department of Health; 2016.

49.

Smith P, McKeon A, Blunt I, Edwards N. NHS hospitals under pressure: trends in acute activity up to 2022. 2014:https://www.nuffieldtrust.org.uk/files/2017-01/hospitals-under-pressure-web-final.pdf. (Accessed 10 Jan 2018).

50.

Department of Health. Integration and Better Care Fund Policy Framework 2017–19. 2017: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/607754/Integration_and_BCF_policy_framework_2017-19.pdf. (Accessed 10 Jan 2018).

Title: Shared decision making and experiences of patients with long-term conditions: has anything changed?
Authors: Reem Kayyali
Shereen Nabhani Gebara
Iman Hesso
Gill Funnell
Minal Naik
Thuy Mason
Mohammed Ahsan Uddin
Noor Al-Yaseri
Umar Khayyam
Teebah Al-Haddad
Roshan Siva
John Chang
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3575-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Shared decision making and experiences of patients with long-term conditions: has anything changed?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Healthcare resource use and economic burden attributable to respiratory syncytial virus in the United States: a claims database analysis

A categorisation of problems and solutions to improve patient referrals from primary to specialty care

Measurement approaches in continuum of care for maternal health: a critical interpretive synthesis of evidence from LMICs and its implications for the South African context

Comparative impact of two continuing education activities targeted at COPD educators on educational outcomes: protocol for a non-randomized controlled study using mixed methods

Electronic health record tools to assist with children’s insurance coverage: a mixed methods study

Core knowledge translation competencies: a scoping review