ISQUA18-2405Sharing Decision Making (SDM) Approach Applicable to Whole Hospital - A Medical Center in Northern Taiwan

Abstract

Objectives: In Taiwan, at least 20% of people with diabetes need insulin to control their blood sugar, but patients are reluctant to accept insulin therapy. According to the study, the reasons including patient's cognition, attitude, ability, psychosocial / social disorders and other chronic conditions. Therefore, even after receiving insulin therapy, many people are worried that insulin may cause blindness, renal dialysis or even amputation. In recent years, the medical model has shifted to the patient orientation. The medical information can be obtained from multiple channels so that the relationship between doctors and patients is becoming more tense and defensive. In our hospital, there are almost 50% of patients with type 2 diabetes admitted in Department of Endocrinology. The rate of insulin injection is lower than 20%. The project hopes to enhance the health literacy of patients and their families,and improve the blood glucose control and management in T2DM patients through SDM (Shared Decision Making). Methods: This project is based on the four aspects of the Health Literacy model proposed by Sorensen in 2012 and oriented by educational thinking. We designed patient decision aids (PDAs) under the SDM architecture titled “I am type II diabetes but have poor glycemic control and is it a good idea to use insulin?” This manual is designed to help patients to understand diabetes control in a relaxed manner, and add QR code to patients and caregivers to facilitate scanning by mobile phone. At the same time we designed the content of the video for the patient's concerns about insulin. In addition, we have established a link between hospital and outpatient systems (Health Information System, HIS) so that medical staff and patients can communicate through PDAs. We also set up these PDAs on the official website so that patients and their families can view PDAs and talk to their caregivers through web-based platforms. Next, we also use the SDM architecture to train decision coach so that they can interpret and track patients in a structured manner. We established a communication platform within the system, and designs questionnaires to evaluate the patient's concerns, decisions after seeing this tools, and confidence in the control and treatment of diabetes And anxiety levels, the scale of assessment, and assessment for the analysis and review. Results: 98% of patients feel that using this method helps to understand the message of disease care. Fifty percent of patients indicated that they were willing to receive injection therapy and had confidence in the treatment of blood sugar (from 6.5 to 7.9). The patient's anxiety level also dropped significantly (from 8.4 to 6.8). Significant improvement in confidence in controlling blood glucose (from 5.9 to 8.5) and anxiety levels also dropped significantly (from 7.9 to 6.2). The plan shows that the use of SDM can effectively improve patient cognition, enhance patients' confidence in injectable drugs, enhance their confidence in glycemic control and reduce the anxiety caused by uncertainty. Following the patient's HbA1C, we also found that patient control was better than before (10.6% vs 8.7%) after receiving insulin. Conclusion: With this model, people with diabetes and their families can correctly understand their glycemic control and choice of medication, whether in longer hospital stays or short-term outpatient visits, and in this way expressing their own injectable drug problems and concerns. Medical staffs can use this to give patients appropriate solutions and achieve the best possible communication.