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Q uali t a ti v e Expl o r a ti o n :

Q uali t a ti v e Expl o r a ti o n : M inneso t a P a tie n ts ’ R espons e t o T ak i n g a n I n c r e a se d R o l e i n He a l th c a r e. M e thod. W e c onduc t ed t w o Online Digi t al Bulletin Boa r ds (ODBBs) Al l o w ed us t o r ecruit participa n ts s tat e w i de

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Q uali t a ti v e Expl o r a ti o n :

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  1. QualitativeExploration: MinnesotaPatients’Responseto TakinganIncreasedRoleinHealthcare

  2. Method • We conducted twoOnline DigitalBulletinBoards(ODBBs) • Allowedusto recruit participantsstatewide • Offeredfinancialandlogisticaladvantages over traditionalresearch methods • Allowedusto capturereactions to communicationthemesonan • individualbasispriortogroupdiscussion • Tookplace over 5days5 hoursofinputx ~100respondents • Discussionguidecouldevolve as we learned • Separatingboards bygendersimilaritiesanddifferences betweenwomen andmencouldbeobserved MNallianceforpatientsafety

  3. Sample • Allrespondents: • Expressed a willingnesstoexplore new ideas • Hadseenadoctorin thelast12monthsaboutchronicconditionorongoinghealth issue • Equalgenderrepresentation • Betweenages21to 85(sampleskewedolder dueto health-related • requirements) • Nopast 6month qualitativeresearchwork • Hadaccessto computerforpersonal use • Passedatechnologyscreen MNallianceforpatientsafety

  4. Limitations • Sample sizeforthisproject was 100+respondents • Samplesofthis size aremore likelytoyieldresults that aremore reliable, precise,andrepresentativeofthepopulationthansample sizes of traditionalqualitative research • Sample waschosenrandomlyaccordingtodefinedquotas(forpatient behavior andtypes ofillnessesas well asdemographics) • Pleasekeepin mindthat thisisqualitativeresearchto informthe developmentofapatientoutreachcampaign. Itprovidesamore rich contextualtypeofqualitativefeedbackthanmostquantitativesurveys can,butit does nothave the predictabilityofa statisticallysignificant randomsamplequantitativesurvey MNallianceforpatientsafety

  5. Executive Summary • Menandwomenagreethatthey have theprimaryresponsibilityfortheirowntreatment and care withrespecttotheirmedicalissues • Key is toinformthemofwhatthatresponsibility entails • Mostbelieveitincludes actingonnextsteps (making appointments,gettingtestsdone, fillingprescriptions) and watchingforwarningsigns • Fewerbelievethatitis theirresponsibility to document information(warningsigns,nextsteps, prescriptions taken) • Men andwomen areleastlikelytotakeresponsibility forbringingtestresults with themtoappointments MNallianceforpatientsafety

  6. Executive Summary(cont’d) Ingeneral,patientstendedtotake amore activerole in theirmedicalcare if: theyhadmore seriousand/orchronicdiseases theysawmultipleproviders(especiallyif from differentclinics/networks) theywere older theyhadexperiencedmedicalmishaps(first-or second-hand) ProprietaryandConfidential MNAllianceforPatientSafety

  7. Executive Summary(cont’d) BarriersthatMAPSwill need toaddressinclude theseattitudesandbehaviors: “Myprovider has allmyinformationin mycharts” “Myproviders belongtothe samenetworkand they share myinformation” “Mypharmacistprovides informationwhen I getmy prescriptions” “Ican (still) remember– I don’tneed towriteanything down” “Idon’tthink aboutdocumentinganything” “Idon’tknow the questionstoask (mydoctor)” “Myspouse/mom/childtakescare ofthat forme” ProprietaryandConfidential MNAllianceforPatientSafety

  8. Executive Summary(cont’d) Nearlyeveryoneclaimed tokeep alistofsome kind(ifonlyagrocery list) Post-itNotes,calendars,andmessagespostedonrefrigeratorswithmagnetswere alsocommonly usedremindermethods Younger patientswere morelikely tobe“paper- free,”relyingonelectronicremindersandfilingsystems Older patientswere more likely tokeep hard copies,sometimesin (elaborate)filingsystems ProprietaryandConfidential MNAllianceforPatientSafety

  9. Executive Summary(cont’d) • Patientsrespondedwellto ato-do list: thestepswere clear, sixstepsthecorrect number • Theyhadnosuggestionsforadditions • PresentingtheTo-do listas intheThemeO radio adwas themostappealing overall: • Womenfound this approachcompelling,supportive, • empowering,and“notpreachy” • Men likedthedirect approachofthisthemeandagreed with thephilosophy “Youare YourOwnBestMedicine” • Takinga seriousapproachin presentingtheTo-dolist wasendorsedbybothmenandwomen(althoughmany acknowledgedthat theypreferred–andweremore likelyto recall-humorousexecutionsin general) ProprietaryandConfidential MNAllianceforPatientSafety

  10. Executive Summary(cont’d) Amongthereminder productconceptsreviewed,therefrigeratormagnetandnotepadsweremostlikelytobeused(although perhapsnotaseffectiveasactualremindertools) Youngerpatientsalso likedtheelectronicoptions(Smartphoneapp,USBdevice),but older/lesscomputersavvypatientswere lesspositive: for them,apre-loaded filefolderororganizerhad more appeal Webvideosandone-pageinformation thatcame fromproviderswerelikely togetviewedatleastonce(and especially inthewaiting roomor ifhanded torespondentsafteranofficevisit) Fewthoughtthewalletcardwouldgetused or viewed ProprietaryandConfidential MNAllianceforPatientSafety

  11. DetailedFindings MNallianceforpatientsafety

  12. Women’s Organizational Charts: Healthcare Functions My jobisto maintainmy well being/ toseetoitthatI takemymedications,eatthe correct foods, getexercisebutbecarefulnot to overdo, andtoseek out help whenit'sneeded 1stplace isme (doctor was next most often mentionedin1st position) Hediagnosedthecondition,providedtreatment, andinstructionsfor ongoing proceduresthatI canconductat hometohelprelieve the conditionandpreventitfromworsening. My doctor (or self, ifnot in first position) Usuallyaspouse/significantother(but also relatives,pharmacists or physical therapists –or no one) It'smy husband’sjobto emotionallysupport meandgoto doctor's visitsif I wanthimto… gotothegrocerystore andgetsomething for meifIneedit, if I'msick,etc. Usuallyno one Q. Thinkingintermsofthe chronic diseaseor illnessyouareliving with, pleasetellme: whoare thevariousparticipantsinyourtreatmentand careofyourdisease/illnessand what is the responsibility ofeach? MNallianceforpatientsafety

  13. Men’s Organizational Charts: Healthcare Functions Imakeallmyfood, bloodtesting,physical activityandmedication scheduledecisions. OtherscanmakesuggestionsbutIamthe oneto makethefinaldecision 1stplace isme (doctor was next most often mentionedin1st position) Hetakesthetime to explain thingsaswellas reviewingmy diagnostic testsandtaking appropriateaction. My doctor (or self, ifnot placed in first position) Sheisanintegralpartofmy healthteam…knows myfeelings…canaccompanyme to visits,listen,can ask clarifying questions,andconveytomethings… Without her,I would notbeashealthy. Usuallyaspouse/significantother(but also relatives,pharmacists or physical therapists –or no one) Friends- theyhelpmekeep sanealong with bouncingideasandsuggestionsoff No one (or sometimes friend or relative) Q. Thinkingintermsofthe chronic diseaseor illnessyouareliving with, pleasetellme: whoare thevariousparticipantsinyourtreatment and care of yourdisease/illnessand what istheresponsibilityof each? MNallianceforpatientsafety

  14. Reactions toTo-do List ProprietaryandConfidential MNAllianceforPatientSafety

  15. Numberof items on List is right • Most women andmen thoughtthat the listcontainedthe right numberoftasks(6) Men'sResponse Thisis agood number.It'sthorough withoutbeing overwhelming,and it'salsodividedinto threeeasy toread andunderstand sections. Women’s Response Toomany Toomany Right number Right number Toofew Toofew MNallianceforpatientsafety

  16. To-dosteps areclear Women’s Response Men's Response It'sclearwhat whoever wrote thatlist thinks you shoulddo. Whatis written isclearlystated. Not clear Not Clear Clear I cantellthatthis checklist wouldbe goodto get me to bealittle more awareof my healthand maybe beableto ask morequestions. Clear MNallianceforpatientsafety

  17. Patients are polarized in terms oflikelihoodto bringa medicationlist(many count on their providers tohave) Thisis most importantto mebecauseof thelarge #of MedicationList med's I take. EXTREMELYLIKELYTODO A must,as you may see multipleproviders,and they maynot beaware SOMEWHATLIKELYTODO NEITHER LIKELY NOR UNLIKELY TODO ofthe actionsof anotherdoctor. SOMEWHAT UNLIKELY TO DO EXTREMELY UNLIKELY TO DO I haveallthis infoin mychart already. 0 10 20 30 40 50 I expectthe doctortodo this,not me Women Men Combined It'stoo much work to bring withtoyourDr apptnomatterwhat yourailmentis…It's notgonnagetdone. MNallianceforpatientsafety

  18. Most patientsalso expect theirproviders tohave test results If thisa seriousconditionI bring theinformation,if nota majorproblemor conditionI defaulttotheir recordkeeping. I donotroutinely keeptest records,as theratios and numbersthey contain meannothing to me. These medical recordsIexpectto be kepton fileby my clinic,wherethey won't get lost,and wherepeoplewith accesstomedical deskreferencebooks andpharmocopiae candecipherthe meaningofthe cryptic numbersof thetest results. Test Results EXTREMELYLIKELYTODO SOMEWHATLIKELYTODO I alwayscarrymy latest tests, becausesometimes they havenotreceived results from another providerthat may be necessaryforthem to diagnoseandtreatyou correctly. NEITHER LIKELY NOR UNLIKELY TODO SOMEWHAT UNLIKELY TO DO EXTREMELY UNLIKELY TO DO 0 10 20 30 40 50 My doctor alreadyhas accesstothis onthe computer. Combined Women Men I goto the same networkofclinicsthat haveaccessto the records. MNallianceforpatientsafety

  19. Patientswithprogressiveconditionsseem more likelytokeep awarningsignslist If Ihavepaper/pen, and my docdoesn't give me a printedlist, I will write it down. WriteWarningSigns List EXTREMELYLIKELYTODO If thedoctorwould warn meto watch fora symptom that would indicatea possible medicalconditionyou betterbelieveit would bedocumented SOMEWHATLIKELYTODO NEITHER LIKELY NOR UNLIKELY TODO SOMEWHAT UNLIKELY TO DO EXTREMELY UNLIKELY TO DO too manywarning signsforthe medsI take 0 5 10 Women Men 15 20 25 30 35 Combined A listisalreadyprovided withanyprescription…it wouldbeawaste of time. MNallianceforpatientsafety

  20. Patients claim that next steps are noted (ifnot always documentedby them) You shouldalwaysask 'where do we go from here'. Good chance toaskifmedsshouldbeadded, WriteaNext Steps List reduced,orstopped. Also, what behavioralmodificationsare necessaryto improveyour physicalcondition EXTREMELYLIKELYTODO SOMEWHATLIKELYTODO If mydoctorgave me next stepsverbally, I would definitelywrite themdown. Iwould assume,thatthiswould beprintedout forme by theprovider. NEITHER LIKELY NOR UNLIKELY TODO SOMEWHAT UNLIKELY TO DO I wouldnotthinkto ask. EXTREMELY UNLIKELY TO DO 0 5 10 Women Men 15 20 25 30 35 Combined I feellike so farIcan rememberwhatI'm toldaboutanyfuture steps there maybe, so Idon't feelthe needtowrite them down. I goto the same networkso Iwouldjustlisten tothedoctoranddowhat she said. Myconditionisnot so complexthat Ineedto write itdown.I leavethedoctorsofficewith steps andrecommendationsonaprint out anyway--I couldrefertothatifneed be. MNallianceforpatientsafety

  21. Acting onnext steps is the step that most patients (say they) comply with Because Ihave so manyappointments, ActonNext Steps meds,tests at different clinicsI keepa dailyplanner whichIhavewith me at alltimes. EXTREMELYLIKELYTODO SOMEWHATLIKELYTODO NEITHER LIKELY NOR UNLIKELY TODO Icare about my well beingand mycare beginswith me. IfI don't complywith treatmentI wouldonly harm myself. SOMEWHAT UNLIKELY TO DO EXTREMELY UNLIKELY TO DO 0 10 20 30 40 women 50 60 70 80 90 men combined MNallianceforpatientsafety 40

  22. Patients alsoclaim towatchfor warningsigns Formethisisveryimportant becauseifI don'tcareabout my body who will. AFTER my last surgeryI endedupwith a staff infectionwhichthanksto meI pushedthepanicbutton andluckycaughtitearly beforeit gotout ofcontrol. WatchforWarningSigns EXTREMELYLIKELYTODO I probablywouldn't makea list,butifIhave concernsIwouldalert the doctor SOMEWHATLIKELYTODO NEITHER LIKELY NOR UNLIKELY TODO SOMEWHAT UNLIKELY TO DO I always dothisso definitelythisone, evenif hypochondriac-ish:) EXTREMELY UNLIKELY TO DO 0 10 20 30 40 50 60 70 Combined Women Men MNallianceforpatientsafety 41

  23. Reactions toThemes ProprietaryandConfidential MNAllianceforPatientSafety

  24. Themes P andO MNallianceforpatientsafety

  25. Themes H andM MNallianceforpatientsafety

  26. Most Persuasive Theme • Anequalnumberof women pickedThemesO,H, andP as“most persuasive”;men preferred P overall,followedbyO • Women’s Response Men'sResponse P 27% O 30% O 30% P 55% M15% H 11% M4% H 28% MNallianceforpatientsafety

  27. Why Theme“O” • Forwomen: • Compelling(talksdirectlyto YOU) • Empowering, supportive • “Doesn’ttalkdown tome” • Formen: • Many agreed philosophically with“you are your ownbest medicine” • Putspatientin charge (appealedtoWarriors) • Addresses the problem (“youneed toget involved”) more than other themes MNallianceforpatientsafety

  28. Roughlyhalfclaim theywould use a preparedfolder (visual shown) I loveto be organized,but usuallydon't havethetime tosetup somethinglike thisforme or my family. Love it! Likelihood to UseFolder Extremely likely to use • Greatorganizational aid • Morelikelyto be maintained Thisis thebest ideaever - everything can be keptinone spot-divided for appointments, bloodwork, prescriptions, allergies,tests and so on - Itcan becarriedto every appointment also Somewhat likely to use Might or might not belikelyto use Somewhat unlikely to use Extremely unlikely to use Thisseems way too clunkyand overbearing. 0 10 20 30 40 I expectthedoctorto beconnected electronically. Idon't want to dragallthis around combined men women ProprietaryandConfidential MNAllianceforPatientSafety

  29. Bothmenandwomenlike“Lifesaving” option; less agreement onpreferences forother options PreferredMagnetDesign 25 20 15 10 5 0 A B C D E F G H I J Women Men Combined PROPRIETARYAND MNallianceforpatientsafety CONFIDENTIAL

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