SHARED DECISION MAKING: CHANGING THE RELATIONSHIP BETWEEN

DOCTOR & PATIENTMARKUS OEI

SANDRA VAN DULMENGLYN ELWYN

TON DRENTHENPAULINE DE HEER

MARLEEN VLEMING & SUSANNE SUZOR-VAN ZWICHT

PLAY 1 (THE “OLD FASHIONED WAY”)

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?

PART 1: SHARED DECISION MAKING

WHAT AND WHY?SANDRA VAN DULMEN

GLYNN ELWYN

E-HEALTH EXAMPLE 1

SDM in context

Prof. dr. Sandra van Dulmen

eHealth week 2016 Amsterdam

Imagine having to make preference sensitive treatment decisions

• Depression• COPD

Prerequisites for three-talk model

Patient- Understanding- Participation- Role in decision-making

Physician- Attitude- Tailoring- Patient experiences

Interaction- Time- Values, preferences and emotions- Respect

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

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…

PART 2: SHARED DECISION MAKING WHAT DO WE NEED?

TON DRENTHENPAULINE DE HEER

MARKUS OEI

PLAY 2 “COMMON PRACTISE” SDM

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

• 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)

Use of • 75% of Dutch GPs use it in their consultation• 60.000-90.000 visits a day

Example: decision aid

Effect Thuisarts.nl at doctor’s visit

Did visit GPDid not visit GP

Huisarts & Wetenschap mei 2015

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.

t.drenthen@nhg.org

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

Bringing the information to the

patient: the missing link

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

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

PART 3: SHARED DECISION MAKING IN CLINICAL

PRACTICE

Shared decision making: Here and now

Dr. Marleen Vleming, MD, PhD, ENT-surgeonDr. Markus Oei, MD, PhD, ENT-surgeon

Results

• High patient satisfaction• Patients choose more conservatively• 25% less operations

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

PARTNERS

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

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

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)

CONNECTED HEALTH INFORMATION PLATFORM

MAY 2016-APRIL 2017

WRAP-UP

TAKE HOME MESSAGES (1)

• SHARED DECISION MAKING• REQUIRES A CHANGE IN ATTITUDE FROM PATIENT AND

DOCTOR• IS ETHICAL• IMPROVES QUALITY OF HEALTH

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

SHARED DECISION MAKING = SHARED HEALTH CARE

• SHARED ATTITUDE• SHARED EFFORT• SHARED CONTENT• SHARED RESOURCES• SHARED TOOLS

• SHARED RESPONSIBILITY

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.

REPEAT AND SHARE THIS SESSION?

•INFORIUM.EU OR INFORIUM.NL

•CODE: EHW2016• YOUR EMAIL ADDRESS (DON’T WORRY ABOUT PRIVACY, IT IS NOT STORED)