Shared Clinical Decision-Making Recommendations for Adult Immunization: What Do Physicians Think?

被引:14
作者
Kempe, Allison [1 ,2 ,3 ]
Lindley, Megan C. [4 ]
O'Leary, Sean T. [1 ,2 ,3 ]
Crane, Lori A. [1 ,2 ,5 ]
Cataldi, Jessica R. [1 ,2 ,3 ]
Brtnikova, Michaela [1 ,2 ,3 ]
Beaty, Brenda L. [1 ,2 ]
Matlock, Daniel D. [1 ,2 ,6 ]
Gorman, Carol [1 ,2 ]
Hurley, Laura P. [1 ,2 ,7 ]
机构
[1] Univ Colorado, Adult & Child Consortium Hlth Outcomes Res & Deli, Sch Med, Aurora, CO USA
[2] Childrens Hosp Colorado, Aurora, CO USA
[3] Univ Colorado, Dept Pediat, Anschutz Med Campus, Aurora, CO 80045 USA
[4] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA
[5] Colorado Sch Publ Hlth, Dept Community & Behav Hlth, Denver, CO USA
[6] Univ Colorado, Div Geriatr, Anschutz Med Campus, Aurora, CO USA
[7] Denver Hlth, Div Gen Internal Med, Denver, CO USA
关键词
shared decision-making; vaccination; ACIP; ADVISORY-COMMITTEE; CARE; GENDER; QUALITY; BARRIERS; WOMEN; MAIL; TIME;
D O I
10.1007/s11606-020-06456-z
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background In 2019, the Advisory Committee on Immunization Practices (ACIP) incorporated the terminology "shared clinical decision-making" (SDM) into recommendations for two adult vaccines. Objective To assess among general internal medicine physicians (GIMs) and family physicians (FPs) nationally (1) attitudes about and experience with ACIP SDM recommendations, (2) knowledge of insurance reimbursement for vaccines with SDM recommendations, (3) how SDM recommendations are incorporated into vaccine forecasting software, and (4) physician and practice characteristics associated with not knowing how to implement SDM. Design Survey conducted in October 2019-January 2020 by mail or internet based on preference. Participants Networks of GIMs and FPs recruited from American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) who practice >= 50% in primary care. Post-stratification quota sampling performed to ensure networks similar to ACP and AAFP memberships. Main Measures Responses on 4-point Likert scales (attitudes/experiences), true/false options (knowledge), and categorical response options (forecasting). Multivariable modeling with outcome of "not knowing how to implement SDM" conducted. Key Results Response rate was 64% (617/968). Most physicians strongly/somewhat agreed SDM requires more time than routine recommendations (90%FP; 95%GIM, p = 0.02) and that they need specific talking points to guide SDM discussions (79%FP; 84%GIM, p = NS). There was both support for SDM recommendations for certain vaccines (81%FP; 75%GIM, p = 0.06) and agreement that SDM creates confusion (64%FP; 76%GIM, p = 0.001). Only 41%FP and 43%GIM knew vaccines recommended for SDM would be covered by most health insurance. Overall, 38% reported SDM recommendations are displayed as "recommended" and 23% that they did not result in any recommendation in forecasting software. In adjusted multivariable models, GIMs [risk ratio 1.44 (1.15-1.81)] and females [1.28 (1.02-1.60)] were significantly associated with not knowing how to implement SDM recommendations Conclusions To be successful in a primary care setting, SDM for adult vaccination will require thoughtful implementation with decision-making support for patients and physicians.
引用
收藏
页码:2283 / 2291
页数:9
相关论文
共 53 条
[1]   The Increasing Number of Clinical Items Addressed During the Time of Adult Primary Care Visits [J].
Abbo, Elmer D. ;
Zhang, Qi ;
Zelder, Martin ;
Huang, Elbert S. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2008, 23 (12) :2058-2065
[2]   Physician gender and screening: Do patient differences account for differences in mammography use? [J].
Andersen, MR ;
Urban, N .
WOMEN & HEALTH, 1997, 26 (01) :29-39
[3]  
[Anonymous], 2015, CAG00439N CTR MED ME
[4]  
[Anonymous], 2014, INTERNET PHONE MAIL
[5]   Considering Mixed Mode Surveys for Questions in Political Behavior: Using the Internet and Mail to Get Quality Data at Reasonable Costs [J].
Atkeson, Lonna Rae ;
Adams, Alex N. ;
Bryant, Lisa A. ;
Zilberman, Luciana ;
Saunders, Kyle L. .
POLITICAL BEHAVIOR, 2011, 33 (01) :161-178
[6]   Shared Decision Making - The Pinnacle of Patient-Centered Care [J].
Barry, Michael J. ;
Edgman-Levitan, Susan .
NEW ENGLAND JOURNAL OF MEDICINE, 2012, 366 (09) :780-781
[7]   Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study [J].
Baumhaekel, Magnus ;
Mueller, Ulrike ;
Boehm, Michael .
EUROPEAN JOURNAL OF HEART FAILURE, 2009, 11 (03) :299-303
[8]   Realizing Shared Decision-making in Practice [J].
Beach, Mary Catherine ;
Sugarman, Jeremy .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2019, 322 (09) :811-812
[9]   Physician gender is associated with the quality of type 2 diabetes care [J].
Berthold, H. K. ;
Gouni-Berthold, I. ;
Bestehorn, K. P. ;
Boehm, M. ;
Krone, W. .
JOURNAL OF INTERNAL MEDICINE, 2008, 264 (04) :340-350
[10]  
Braaf S, 2015, PHARMACIST PATIENT M, V4, P16