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Engaging stakeholders to develop a depression management decision support tool in a tribal health system

  • Patient Engagement Special Section
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Abstract

Purpose

Southcentral Foundation, an Alaska Native tribal health organization, has had a depression screening program in primary care since 2001. Program monitoring identified gaps in antidepressant refills and patients’ follow-up with behavioral health services. With extensive stakeholder participation, we developed an electronic, patient-centered, depression-management decision support tool (DM-DST). Quality of life and other outcomes are being assessed in a separate study; this case study reports on the multi-year stakeholder engagement process.

Methods

Data sources included interviews with patients and providers from integrated primary care teams, notes from research meetings, steering committee meetings, and consultations with tribal health system leadership, human subjects review committees, providers, and software designers, and a pilot test of the DS-DMT with patients and providers. We analyzed these sources using qualitative methods to assess the impact of stakeholder input on project processes and outcomes.

Results

One comprehensive, iPad-based tool was originally planned to facilitate discussions about depression management. Stakeholder input emphasized the role of family and cultural context of depression and management and improving the usability of the DM-DST. Stakeholder direction led us to split the DM-DST into: (1) a brief iPad-based tool to facilitate conversations between patients and providers during clinic visits; and (2) a complementary Web site that provides detailed information and allows patients flexibility and time to learn more about depression and share information and preferences with family and friends.

Conclusions

Stakeholder input across the project substantially modified the DM-DST to ensure cultural applicability to patients and providers and facilitate integration into clinics.

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References

  1. Clinical and Translational Science Awards Consortium, Community Engagement Key Function Committee Task Force. (2011). Principles of community engagement (pp. 11–7782). Bethesda: NIH Publication no.

    Google Scholar 

  2. Tapp, H., & Dulin, M. (2010). The science of primary health-care improvement: Potential and use of community-based participatory research by practice-based research networks for translation of research into practice. Experimental Biology and Medicine, 235, 290–299.

  3. Campinha-Bacote J. (2011). Delivering patient-centered care in the midst of a cultural conflict: The role of cultural competence. Online Journal of Issues in Nursing, 16(2), Manuscript 5.

  4. Beach MC., Saha S., & Cooper LA. (2006). The role and relationship of cultural competence and patient-centeredness in health care quality. The Commonwealth Fund, Publication 960, http://www.commonwealthfund.org/~/media/files/publications/fund-report/2006/oct/the-role-and-relationship-of-cultural-competence-and-patient-centeredness-in-health-care-quality/beach_rolerelationshipcultcomppatient-cent_960-pdf.pdf. Accessed August 26, 2014.

  5. Grundy, P., Hagan, K. R., Hansen, J. C., & Grumbach, K. (2010). The multi-stakeholder movement for primary care renewal and reform. Health Affairs (Millwood), 29, 791–798.

    Article  Google Scholar 

  6. Gottlieb K. (2013). The Nuka System of Care: Improving health through ownership and relationships. International Journal of Circumpolar Health Aug 5: 72. doi: 10.3402/ijch.v72i0.21118.

  7. Dillard, D. A., & Christopher, D. (2007). The Southcentral Foundation Depression Collaborative. International Journal of Circumpolar Health, 66, 45–53.

    PubMed  Google Scholar 

  8. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Kroenke, K., Spitzer, R. L., Williams, J. B., & Lowe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359.

    Article  PubMed  Google Scholar 

  10. Gerring, J. (2004). What is a case study and what is it good for? American Political Science Review, 98, 341–354.

    Article  Google Scholar 

  11. Yin R. K. (2009). Case study research: Design and methods. Thousand Oaks.

  12. Begoray D. L., & Banister E. L. (2010). Reflexivity. In A. J. Mills, G. Durepos, & E. Wiebe (Ed.), Encyclopedia of Case Study Research. L-Z Index: Sage.

  13. Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., et al. (2013). Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs (Millwood), 32, 223–231.

    Article  Google Scholar 

  14. Pinto R. M., Spector A., Rahman R., & Gastolomendo J. D. (2013). Research advisory board members’ contributions and expectations in the USA. Health Promotion International. [Epub ahead of print].

  15. Elwyn, G., O’Connor, A. M., Bennett, C., Newcombe, R. G., Politi, M., et al. (2009). Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One, 4, e4705.

    Article  PubMed Central  PubMed  Google Scholar 

  16. O’Connor A.M., Bennett C. L., Stacey D., Barry M., Col N. F., et al. (2009). Decision aids for people facing health treatment or screening decisions. Cochrane Database System Review: CD001431.

  17. Legare, F., Turcotte, S., Stacey, D., Ratte, S., Kryworuchko, J., et al. (2012). Patients’ perceptions of sharing in decisions: A systematic review of interventions to enhance shared decision making in routine clinical practice. Patient, 5, 1–19.

    Article  PubMed  Google Scholar 

  18. Sepucha, K. R., Borkhoff, C. M., Lally, J., Levin, C. A., Matlock, D. D., et al. (2013). Establishing the effectiveness of patient decision aids: Key constructs and measurement instruments. BMC Medical Informatics and Decision Making, 13(Suppl 2), S12.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Stacey, D., Kryworuchko, J., Belkora, J., Davison, B. J., Durand, M. A., et al. (2013). Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence. BMC Medical Informatics and Decision Making, 13(Suppl 2), S11.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Gottlieb, K., Sylvester, I., & Eby, D. (2008). Transforming your practice: What matters most. Family Practice Management, 15, 32–38.

    PubMed  Google Scholar 

  21. Johnson, C., Gunn, J., & Kokanovic, R. (2009). Depression recovery from the primary care patient’s perspective: ‘Hear it in my voice and see it in my eyes’. Mental Health in Family Medicine, 6, 49–55.

    PubMed Central  PubMed  Google Scholar 

  22. Raue, P. J., Schulberg, H. C., Lewis-Fernandez, R., Boutin-Foster, C., Hoffman, A. S., et al. (2010). Shared decision-making in the primary care treatment of late-life major depression: A needed new intervention? International Journal of Geriatric Psychiatry, 25, 1101–1111.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Barratt, A. (2008). Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient Education and Counseling, 73, 407–412.

    Article  PubMed  Google Scholar 

  24. Barry, M. J. (2012). Shared decision making: informing and involving patients to do the right thing in health care. The Journal of Ambulatory Care Management, 35, 90–98.

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by a grant from the Patient-Centered Outcomes Research Institute, Renee Robinson, PI.

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Authors and Affiliations

  1. Research Department, Southcentral Foundation, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK, 99508, USA

    Jennifer L. Shaw, Vanessa Hiratsuka, Denise A. Dillard & Renee Robinson

  2. Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, 98195-7120, USA

    Helene Starks

Authors
  1. Helene Starks
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  2. Jennifer L. Shaw
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  3. Vanessa Hiratsuka
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  4. Denise A. Dillard
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  5. Renee Robinson
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Corresponding author

Correspondence to Renee Robinson.

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Starks, H., Shaw, J.L., Hiratsuka, V. et al. Engaging stakeholders to develop a depression management decision support tool in a tribal health system. Qual Life Res 24, 1097–1105 (2015). https://doi.org/10.1007/s11136-014-0810-9

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  • DOI: https://doi.org/10.1007/s11136-014-0810-9

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