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Shared Decision Making in England


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2013 Winter Medical Editor's Meeting: Angela Coulter, PhD

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Shared Decision Making in England

  1. 1. Shared Decision Making in EnglandAngela CoulterDirector of Global InitiativesJanuary 2013
  2. 2. Overview• Foundation’s role• Policy context• Three SDM programmes• Health Foundation• NHS• Bupa• What next?2
  3. 3. Urology Decision Aids3
  4. 4. Influencing the Policy Agenda4
  5. 5. No Decision About Me Without Me“The Government’s ambition is to achievehealth care outcomes that are amongst thebest in the world.This can only be realised byinvolving patients fully in their own care, withdecisions made in partnership with clinicians,rather than by clinicians alone.”Department of Health. Equity and Excellence: Liberating the NHS, July 20105
  6. 6. Patients’ rights• You have the right to make choices aboutyour NHS care and to information to supportthese choices.• You have the right to be involved indiscussions and decisions about yourhealthcare, and to be given information toenable you to do this.• You have the right to be given informationabout your proposed treatment in advance,including any significant risks and anyalternative treatments which may beavailable, and the risks involved in doingnothing.6
  7. 7. Good Medical Practice: Duties of a doctor• You must work in partnership with patients• Listen to patients and respond to their concerns and preferences• Give patients the information they want or need in a way they canunderstand• Respect patients right to reach decisions with you about theirtreatment and care• Support patients in caring for themselves to improve and maintaintheir health General Medical Council 20097
  8. 8. NHS Patients’ Experience46 46 47 47 48 49 48 48 48 4801020304050607080901002002 2003 2004 2005 2006 2007 2008 2009 2010 2011%Wanted more involvement in treatment decisionsSource: NHS inpatient surveys8
  9. 9. Health Foundation9Newcastle – RichardThomsonCardiff – Glyn ElwynSpecialties: general practice, obstetrics, breast surgery, ENT, urology• Option Grids• Clinical skill development• Action learning sets• Measurement and feedback• Ask 3 Questions campaign• Engaging organisations and teams
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  11. 11. Ahmed H et al. BMJ 2012;344:bmj.e3996©2012 by British Medical Journal Publishing GroupBreast Cancer Decision ExplorerBresDex: www.bresdex.com11
  12. 12. Social Marketing: Ask 3 Questions12
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  14. 14. MAGIC: Successes and ChallengesSuccesses• Training programmes andmaterials• Brief PtDAs, inc OptionGrids• Decision quality measuresand metrics• Ask 3 Questions• Resource centre• Policy influenceChallenges• Sustainability of training• Cultural/organisationalbarriers• Decision quality measuresneed more work• Standardising tooldevelopment• Patient engagementstrategies14
  15. 15. QIPP Right Carewww.rightcare.nhs.uk1. Developing tools to support SDM• 38 web-based patient decision aids + mobile apps• Telephone health coaching service2. Embedding SDM in NHS systems• Integration into IT systems• Guidance for commissioners3. Creating a receptive culture for SDM• Training for clinicians and demonstration sites• Involving patient advocates, developing metrics15
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  17. 17. NHS Right Care Decision AidsAvailable now To come To comeEstablished kidney failure Multiple sclerosis DepressionKidney dialysis Localised bladder cancer Atrial fibrillationKidney transplant Pregnancy after C section SciaticaCataracts Heavy menstrual bleeding Inguinal herniaAAA repair Rheumatoid arthritis AcneAAA screening Carpal tunnel CholecystitisOA hip Localised breast cancer ObesityOA knee Otitis media Antenatal screeningLUTS Tonsillitis End of life carePSA testing Type 2 diabetesCOPD Smoking cessationLocalised lung cancer CholesterolStable angina Localised bowel cancerLocalised prostate cancer Blood pressure 17
  18. 18. Right Care: Successes and ChallengesSuccesses• PtDAs developed to tighttimescale• Clinician involvement• Linkages and systemsupport• Policy influenceChallenges• Short-term funding• Sustainability• Embedding in system• Cultural/organisationalbarriers• Decision quality measuresneed more work18
  19. 19. Bupa UKTreatment Options Service19• 9 nurses target members by phone• Supported 10,292 members to dateProgramme• SDM• ‘Whole person’ health coachingProcess• MSK, cardio, cancer, gastroenterology• Urology, derma, mental, post-surgeryConditions• Patients like it, costs covered• Company contract for weight managementBenefits
  20. 20. 35-7% gross cost savings 3months post engagement(RCT)Called 34,386 membersReached 25,877 (75%)Engaged 10,292 (40%)Savings hold up at least 1.5years post engagementCost Outcomes
  21. 21. Positive Reaction from Patients21“I found the decision aid onchronic low back painfantastic and have discussedthis with my GP. He hasreviewed my medicationsand reduced my analgesia,and I have also startedexercising at a local gym.”“The DVD and book wasabsolutely brilliant. Ihave cancelled myoperation and found apositive way to deal withpain which gave me anoption other thansurgery. Thank you somuch for all your help.”
  22. 22. Bupa: Successes and ChallengesSuccesses• Saving of 5-7% covers costof provision• Great feedback – 79%extremely or very satisfied• Provides right care andadvice• Demonstrates Bupa’sleadershipChallenges• Engaging clinicians• Referrals into the teamfrom clinicians• Promoting use of SDM byclinicians• Bupa members only(private medicne, not NHS)22
  23. 23. What Next in England?• Adoption by NCB and CCGs• Mainstreaming in clinical practice• Wider range of PtDAs• PtDA certification• Metrics and DQM• ICD10 code for provision of PtDA• Wider availability of training• Building patient awareness23