shared decision making: changing the relationship between doctor and patient
TRANSCRIPT
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SHARED DECISION MAKING: CHANGING THE RELATIONSHIP BETWEEN
DOCTOR & PATIENTMARKUS OEI
SANDRA VAN DULMENGLYN ELWYN
TON DRENTHENPAULINE DE HEER
MARLEEN VLEMING & SUSANNE SUZOR-VAN ZWICHT
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PLAY 1 (THE “OLD FASHIONED WAY”)
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PROGRAM
Part 1: Why Shared Decision Making and what is it?Part 2: What resources and eHealth tools do we need? Part 3: How can we use it in clinical
practice?
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PART 1: SHARED DECISION MAKING
WHAT AND WHY?SANDRA VAN DULMEN
GLYNN ELWYN
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E-HEALTH EXAMPLE 1
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SDM in context
Prof. dr. Sandra van Dulmen
eHealth week 2016 Amsterdam
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Imagine having to make preference sensitive treatment decisions
• Depression• COPD
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Prerequisites for three-talk model
Patient- Understanding- Participation- Role in decision-making
Physician- Attitude- Tailoring- Patient experiences
Interaction- Time- Values, preferences and emotions- Respect
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Web-based decision support tools- Video Zorgkeuzelab
- Decision support tools enhance patient involvement1 and force- Physicians to attend to patient values and preferences- Patients to think about their values and preferences
- Decision support tools1
- Increase knowledge and risk perception- Decrease decisional conflict
- As a result, better adherence and quality of life2 and less invasive tests3 1 Van Weert et al, 2016
2 Stacey et al, 20083 Knops et al, 2013
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Meanwhile in daily clinical practice….
-Many patients have no idea that they have a choice
-Medical arguments weight more in decision-making than patient preferences
-Physicians do not inquire about their values and preferences in 1/5 of the visits
-30% of patients want their physician to make the decision, especially when being seriously ill, even then…
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PART 2: SHARED DECISION MAKING WHAT DO WE NEED?
TON DRENTHENPAULINE DE HEER
MARKUS OEI
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PLAY 2 “COMMON PRACTISE” SDM
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Decision aids as an integrated part of a website with evidence-/guideline-based information on health and disease
Ton Drenthen, PhDDept. Prevention and Patient educationDutch College of GPs
Amsterdam, June 9, 2016
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• Founded in 1956• 90% of GPs is member of NHG (>11.000 members)• Mission: support and improve evidence-based
general practice• One of the activities: supporting GPs in patient
education
Dutch College of General Practitioners (NHG)
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Use of • 75% of Dutch GPs use it in their consultation• 60.000-90.000 visits a day
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Example: decision aid
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Effect Thuisarts.nl at doctor’s visit
Did visit GPDid not visit GP
Huisarts & Wetenschap mei 2015
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Future• Addition with specialist medical information• More decision aids and option grids• Multimedia: more videos and images• Extension to eHealth platform:
– Making appointments– Linking patient records– Etc.
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Improving information availability for patients The role of the government
Pauline de HeereHealth week, 9 June 2016
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National Health Care Institute (Zorginstituut Nederland in Dutch)
Main tasks:• Coverage of the Health Insurance Act and Long-Term Care Act• Risk adjustment for Health Insurance companies• Facilitating good health care and quality improvement• Reviewing health care professions and education, and future needs
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Health Care Quality: facilitating good health care• Contributes to good health care by helping
– parties involved to continually improve health care quality – patients find their way to good-quality care
• Makes quality transparent– Care-providers measure the outcomes of care, based on quality
standard– Health Care Quality programme publishes quality
information › public database with open data› kiesBeter.nl for patients
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Website kiesBeter.nl (chooseBetter)
Aim:Providing user-friendly access to information on good health care in the Netherlands
Providing access: referring where possible, otherwise offer information ourselves
Focus on good health care:• What is good health care? • Where can I find good health care? (quality of health care providers)
+• Where can I find other trustworthy information?
Currently 175 pages on diseasesand 10 guides to health care themes
Currently information on 2,000 health care organisations within 7 sectorsCurrently links to more than 2,000
guidelines, websites, option grids, etc.
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Other activities to help patients get good information
• Support and cooperate with (patient) organisations to improve and share their patient information
• Public database with open data on quality of health care
• All KiesBeter pages are shared with Betrouwbare Bron and Inforium
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Focus shift : to doctor-patiënt
InformationDecision aidsApp(lication)s
Shared Database
DoctorPatiënt
But everybody uses email! (80-100%)
Acceptance:Personal health record 0-10 %Health portal 0-10%Apps ??
With respect for privacy
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Features and acceptance
• Very easy to use (for doctor and patiënt )• Privacy issues solved
• accepted by hospital security officers, privacy experts and organizations
• Acceptance by patiënts: over 80% (92% in our clinic)• Patiënts love it
• Rating over 8• Several nominations/ awards
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PART 3: SHARED DECISION MAKING IN CLINICAL
PRACTICE
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Shared decision making: Here and now
Dr. Marleen Vleming, MD, PhD, ENT-surgeonDr. Markus Oei, MD, PhD, ENT-surgeon
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Results
• High patient satisfaction• Patients choose more conservatively• 25% less operations
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SHARED DATABASE OF MEDICAL INFORMATION AND DECISION AIDSTRANSMURAL, REGIONAL, STANDARD PATIENT INFORMATION TOOL MAY 2016-APRIL 2017
PROJECT CHIP- CONNECTED HEALTH INFORMATION PLATFORM:
PUTTING IT ALL TOGETHER
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PARTNERS
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CITY OF ALMERE 8TH LARGEST CITY IN THE NETHERLANDS
POPULATION 200.000
START IMPLEMENTATION JUNE 2016• 50% OF THE GENERAL PRACTITIONERS• 80% PHARMACIES• 25% PHYSIOTHERAPISTS• 30% FLEVOZIEKENHUIS (HOSPITAL)
• OTHER HEALTH DISCIPLINES• SCALE-UP OTHER REGIONS
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SHARED DATABASE
• NATIONAL ORGANIZATIONS: DECISION AIDS AND RELIABLE HEALTH INFORMATION• GOVERNMENTAL • MEDICAL • NON-PROFIT ORGANIZATIONS • PATIENT ORGANIZATIONS
• LOCAL ORGANIZATIONS: LOCAL INFORMATION• FLEVOZIEKENHUIS (HOSPITAL)• ALMERE CARE GROUP (HOME PHYSICIANS, PHARMACISTS, PHYSIOTHERAPISTS)• OTHER PROFESSIONALS
• HEALTH PROFESSIONALS: SHARE ACCESS TO HEALTH INFORMATION AND DECISION AIDS
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WHAT’S IN IT FOR THE PATIENT?
• TAILORED INFORMATION FOR MORE GRIP AND UNDERSTANDING OF HIS DISEASE AND TREATMENT OPTIONS
• A PATIENT INFORMATION RECORD (NOT PHR) IN HIS OWN MAILBOX, APPLICATION OR APP
• PATIENT IS THE CORE (OWNER)• CAN DECIDE TO SHARE, DELETE, STORE ALL RECEIVED INFORMATION• IT’S FREE!
• TRANSMURAL USAGE• MEDICAL INFORMATION/DECISION AIDS SENT BY ALL HEALTH
PROFESSIONALS/ORGANIZATIONS• COÖRDINATED INFORMATION
• GATEWAY TO MEDICAL APPS, APPLICATIONS, PORTALS, PERSONAL HEALTH RECORDS (PHR)
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CONNECTED HEALTH INFORMATION PLATFORM
MAY 2016-APRIL 2017
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WRAP-UP
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TAKE HOME MESSAGES (1)
• SHARED DECISION MAKING• REQUIRES A CHANGE IN ATTITUDE FROM PATIENT AND
DOCTOR• IS ETHICAL• IMPROVES QUALITY OF HEALTH
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TAKE HOME MESSAGE (2)
• SHARED DECISION MAKING• NEEDS RELIABLE, REPEATABLE, UNDERSTANDABLE
CONTENT AND DECISION AIDS• NEEDS SUPPORT FROM ALL HEALTH ORGANIZATIONS AND
GOVERNMENT• NEEDS TO REACH THE PATIENT
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SHARED DECISION MAKING = SHARED HEALTH CARE
• SHARED ATTITUDE• SHARED EFFORT• SHARED CONTENT• SHARED RESOURCES• SHARED TOOLS
• SHARED RESPONSIBILITY
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MISSION
• NEW TECHNOLOGIES COME WITH GREAT OPPORTUNITIES, BUT ALSO WITH THE RISK OF PRESENTING PEOPLE WITH AN OVERLOAD OF INFORMATION. WE TOGETHER HAVE TO DESIGN SUPPORTING MATERIALS AND METHODS IN A SUCH A WAY THAT SHARED DECISION-MAKING IS TRULY SUPPORTED.
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REPEAT AND SHARE THIS SESSION?
•INFORIUM.EU OR INFORIUM.NL
•CODE: EHW2016• YOUR EMAIL ADDRESS (DON’T WORRY ABOUT PRIVACY, IT IS NOT STORED)