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Improving completion of advance directives in the primary care setting: a randomized controlled trial.
- Source :
-
The American journal of medicine [Am J Med] 2004 Sep 01; Vol. 117 (5), pp. 318-24. - Publication Year :
- 2004
-
Abstract
- Background: Since 1991, hospitals have asked patients whether they have advance directives, but few patients complete these documents. We assessed two simple interventions to improve completion of advance directives among elderly or chronically ill outpatients.<br />Methods: We conducted a cluster randomized controlled trial involving 1079 patients from five general medicine clinics that were affiliated with an academic medical center. Patients were either > or =70 years of age or > or =50 years old with a chronic illness. The study comprised three arms: physician reminders recommending documentation of advance directives, physician reminders plus mailing advance directives to patients together with educational literature, or neither intervention (control). The main outcome measure was completion of an advance directive.<br />Results: After 28 weeks, 1.5% (5/332) of patients in the physician reminder group, 14% (38/277) in the physician reminder plus patient mailing group, and 1.8% (5/286) in the control group had completed advance directives. In multivariate analyses, patients in the physician reminder plus patient mailing group were much more likely than controls to have completed advance directives (odds ratio [OR] = 5.9; 95% confidence interval [CI]: 1.5 to 22), whereas patients in the physician reminder-only group were no more likely than controls to have completed advance directives (OR = 0.88; 95% CI: 0.21 to 3.7).<br />Conclusion: Mailing health care proxy and living will forms and literature to patients before an appointment at which their physicians received a reminder about advance directives yielded a small but significant improvement in completion of these documents. A physician reminder alone did not have an effect.
- Subjects :
- Adult
Advance Care Planning statistics & numerical data
Age Factors
Aged
Attitude of Health Personnel
Chronic Disease
Female
Health Knowledge, Attitudes, Practice
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Outcome Assessment, Health Care
Patient Acceptance of Health Care statistics & numerical data
Physicians statistics & numerical data
Practice Patterns, Physicians' standards
Practice Patterns, Physicians' statistics & numerical data
Sex Factors
Total Quality Management organization & administration
Advance Care Planning standards
Correspondence as Topic
Patient Acceptance of Health Care psychology
Physicians psychology
Primary Health Care standards
Reminder Systems standards
Subjects
Details
- Language :
- English
- ISSN :
- 0002-9343
- Volume :
- 117
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 15336581
- Full Text :
- https://doi.org/10.1016/j.amjmed.2004.03.027