In recent years, there has been significant interest and investment for conducting comparative effectiveness research (CER) of medical treatments for common medical conditions. AHRQ has invested a significant amount of money and resources to advance CER. However, little is known about translating the findings from CER into practice. CER of diabetes treatments suggests that all medications are similar in their effects on glycemic control, but there is variability in side-effects, which may affect medication adherence and treatment intensification. Greater patient involvement in making decisions, facilitated by decision aids, may enhance the quality of diabetes care by enhancing the patient-provider communication and improving the uptake and adherence to the medication that is consistent in their features and goals with patients'values and preferences. To promote patient involvement in this decision, we have developed and conducted a pilot randomized trial of a decision -- the Diabetes Medication Choice cards decision aid. In this application, we aim to assess methods and strategies for translating the findings from the CER on oral diabetes medications into primary care practices by conducting a practical cluster randomized trial. We will assess patient adherence to medications and success in reaching glycemic control goal. In conjunction with this trial, we will apply the Normalization Process Theory and mixed methods research (qualitative and quantitative) to identify factors that promote the incorporation of decisions aids for translating CER into routine clinical workflow for providers. We will also explore how this theory may enable patients to incorporate their choice into their daily routines. At the completion of this trial, we will gain insight into the use of decision aids as a strategy for the translation of CER into practice. This research will also identify factors that allow for successful implementation into practice. Finally, we will better understand the impact of patient involvement in the decision on treatment adherence.
Patients with diabetes often do not reach their goals for blood sugar control. It is often difficult for patients and providers to identify optimal medications to manage diabetes since there is evidence that all medications have similar effects on blood sugar. Further, patients often do not take their medications as prescribed, potentially due to side-effects. In this study, we propose to study how using a decision aid during a patient office visit - a tool that helps patients understand the benefits and side-effects of each of the medications - can help patients make a decision and stick to their decision. We will also study what community-based practices need to do to effectively use these decision aids as part of their routine, and what factors affect the integration of the medication choice into patients'daily lives.
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