Closing the Loop: Following up with Patients

 

The most integral part of Shared Decision Making is helping patients make an informed, empowered choice. Research shows that there are both patient and provider benefits when patients play a significant role in deciding how they are going to treat or manage their health conditions. Patients feel better about their decision and are more likely to stick with the regimens the treatment requires—and often rate their health higher after treatment. For clinicians, this translates into the potential for:

  1. Patients who are more empowered to manage their health/treatment;
  2. Reductions in unwarranted variation of care;
  3. Increased awareness among patients regarding potential adverse consequences from a medical decision/treatment option; and
  4. Overall increase in the quality of patient care.

Clinic Provisions for Decision Support
Working with patients to follow-up on their shared medical decision is not a concrete process. The clinician and medical staff should work in tandem to provide follow-up services (if needed) and be available to answer questions so the patient feels informed and empowered throughout the process.

In some cases, this process may be accomplished over the phone or via email (avoiding a second co-pay for the patient). However, sometimes another in-person visit is necessary. You should identify the process that works best for your clinic and the DA in question. A DA about aging may not require the same intensity of follow up as one about breast cancer treatment options.

People in the following roles can be instrumental in providing decision support:

  • Clinician. Patients who want further consultation can schedule a separate follow-up visit. Clinicians can help the patient make a choice in the context of what is personally important to them.
  • Health Educator/Care Coordinator. Health educators or care coordinators are trained staff positions that may provide decision support to patients. They can help follow-up with patients who have received the DAs in-person or over the phone, and can help facilitate follow-up appointments with the medical clinician should addition input and consultation be necessary.
  • Nursing Staff or Medical Assistants. Medical assistants and nursing staff can also assist with closing the loop. Clinicians should work with their team to develop protocols for decision support and strategies for additional help as needed.
  • Group Visits. Group visits can serve as both a venue for viewing DAs and as a way to facilitate decision support. Instead of individual clinic visits or one-on-one phone calls, a group of patients with a similar medical condition are invited to the clinic to discuss potential treatment choices. These visits are frequently facilitated by a clinician/nurse team and provide an opportunity for patients to have an open dialogue with their health care team as well as to hear about the experience and choices that their peers may be facing.

 

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