PS2-33: Patient Characteristics Associated with Medication Adherence
Clinical Medicine & Research
Background/Aims: Primary Care Providers (PCPs) are seeing more complex patients who were previously managed by specialists. PCPs may not have the time or expertise to fully elicit or evaluate all patient complaints, or apply the detailed evidence required to manage these conditions. We describe provider experience with eCVD, a web-based cardiovascular disease (CVD) management system for use in primary care. eCVD incorporated a shared-decision making (SDM) tool linked to a clinical decision
... nical decision support (CDS) tool that, together, were designed to promote the development of preference-sensitive and evidence-based care plans. Methods: Prior to a primary care encounter, patients completed a behavioral risk factor questionnaire to calculate their CVD risk. Patients at elevated risk used the eCVD system, which included an SDM tool that informed patients of their CVD risk, educated them on the types and benefits of risk factorspecific treatment options, and allowed them to select their preferred treatment options. Via an alert embedded in the electronic health record (EHR), the provider could access a CDS tool displaying both tailored, guideline-based recommendations and the patient's chosen treatment preferences. We tracked use of the CDS and conducted structured interviews with providers to understand their experience with eCVD. Interview domains included: logistics/workflow, mode of presentation, content, patient preferences, and improving efficiency/effectiveness. Results: The CDS alert was presented for 118 patients; only 21.2% were opened by providers. Initial review of interview data showed that providers did not open the CDS alert due to time constraints or because it was indistinguishable from other EHR alerts. Providers stated that they believe discussing a patient's preferences for care is important but difficult to do with complex patients because of the time needed to: 1) review all relevant data; 2) determine additional data needs (e.g., labs); 3) determine the appropriate clinical course of action; and 4) educate the patient. Conclusions: Models of technology adoption highlight the importance of usefulness and usability of a tool like eCVD. Our data suggest that, while the SDM/CDS content was useful, usability issues remain. Detailed thematic analysis of how the tool was accessed and the functionality it provided will be completed in December 2010.