Can a proposed risk assessment and communication tool help New Zealand general practitioners and patients?

Problem

Participating in shared decision-making, understanding the rationale for treatment, and being able to identify potential side effects can maximise wellness for patients across the life course. However these tasks are difficult due to structural barriers, language, cultural barriers, bias, and limited resources appropriately tailored for the health literacy of most patients. These factors contribute to health inequity based on ethnicity and socioeconomic disadvantage, which is widespread in Aotearoa New Zealand (NZ). Decision support tools can address these issues. A novel decision support tool was proposed to alert prescribers of patients at risk of medication harm and provide tailored risk information for patients. It aims to facilitate discussion about medications and support informed decision-making with patients and their whānau (family). This early phase co-design research aims to determine what GPs and patients think about the proposed tool, what factors they felt would increase its utility and avoid increasing health inequity.

Approach

Fifteen patients (five Māori, five Pasifika and five NZ European) and nine GPs (two Māori and seven European) prospectively evaluated the proposed tool. Semi-structured interviews were based on a topic guide informed by Normalisation Process Theory (NPT). A deductive thematic analysis was conducted into the relevant NPT domains.

Findings

Three themes were identified. Theme 1 investigated participants’ understanding of prescribing safety, medication harm and risk; this is based on experience. Patients want comprehensive information about their medications and potential risk, but doctors find it difficult to communicate that information. Patient participants were keen to actively participate in shared decision making about their healthcare, whereas doctors described a wider range of interest in patient participation. Theme 2 explored what participants thought about a prescribing decision support tool; they were cautiously optimistic, but worried about potential harm arising from its use. Participants identified both requirements for the tool and features to avoid. Theme 3 describes the collective action required for successful implementation of the tool; namely, culturally safe and trustworthy doctor-patient relationships. Use of Māori and Pacific languages in the proposed tool may enhance engagement and understanding. Patients and general practitioners provided different perspectives when prospectively evaluating the proposed risk assessment and communication tool. NPT provided a comprehensive theoretical framework to conduct this evaluation. This co-design research identified important pre-requisites for the tool and features to avoid, as well as several novel ideas for the proposed tool.

Consequences

Co-designing interventions tailored for the needs of different groups may reduce barriers to receiving healthcare and may reduce inequities arising from use of technological interventions. A multidimensional approach is required to reduce health inequities, founded on culturally safe and trustworthy relationships.