Aligning Care With Patients’ Priorities Improves Outcomes

The findings of a study published in JAMA Internal Medicine suggest that patient priorities care (PPC) may be linked to reduced treatment burden and unwanted health care compared to usual care (UC).

In this non-randomized clinical trial, researchers conducted propensity adjustments at one PPC site and one UC site of a multi-site primary care practice in Connecticut that provides care to approximately 15% of the state’s residents. They recruited 366 patients (64.2% female, 95.6% white) comprised of 163 adults aged 65 or older who had three or more chronic conditions and were cared for by 10 primary care practitioners (PCPs) who were PPC trained, as well as 203 similar patients who received UC from seven PCPs who were untrained in PPC.

All participants were enrolled between February 2017, and March 31, 2018, and follow-up took place until September 30, 2018. The study interventions were PPC and physicians basing their decision making around PPC. The key endpoints were specified as: change in patients’ Older Patient Assessment of Chronic Illness Care (O-PACIC); CollaboRATE, and Treatment Burden Questionnaire (TBQ) scores; electronic health record documentation of decision-making based on patients’ health priorities; medications and self-management tasks added or stopped; and diagnostic tests, referrals, and procedures ordered or avoided.

According to the results, within the UC group, the PPC group was older (mean age, 74.7 vs 77.6) and had both lower physical and mental health scores. At the researchers’ time of follow-up, PPC participants reported a 5-point greater decrease in TBQ score than those who received UC when evaluated with a weighted regression model with inverse probability of PCP assignment weights.

The researchers observed no differences in O-PACIC or CollaboRATE scores. Moreover, the results showed that noted personal health priorities–based decisions were mentioned in clinical visit notes for 66.3% PPC vs 0% UC participants. Furthermore, with UC patients, PPC patients were more likely to have medications stopped (weighted comparison, 52.0% vs 33.8%; adjusted odds ratio [AOR]=2.05; 95% CI, 1.43 to 2.95) and less likely to have self-management tasks (57.5% vs 62.1%; AOR=0.59; 95% CI, 0.41 to 0.84) and diagnostic tests (80.8% vs 86.4%; AOR=0.22; 95% CI, 0.12 to 0.40) ordered.

“This study’s findings suggest that aligning care with patients’ priorities may improve outcomes for patients with multiple chronic conditions,” the study authors wrote.

“Care aligned with patients’ priorities may be feasible and effective for older adults with MCCs.”