Using maintenance of certification to promote advance directive discussions in primary care
Duthie D, Myers J, Simpson D, Denson K, Denson, S. Using maintenance of certification to promote advance directive discussions in primary care. Innovation in Aging, 2017;1(S1): 600.
Background: Physicians and patients agree that primary care visits are the appropriate place to discuss advance directives (AD) with geriatric patients as it normalizes the discussion. Yet barriers are known to keep AD completion rates low.
Methods: An interprofessional team designed and implemented a three-health care system approved AD focused Maintenance of Certification (MOC) Part IV activity for primary care physicians (PCPs) to meet American Board of Medical Specialists (ABMS) requirements. The activity focuses on PCPs initiation of brief (2–3 min) AD conversations with geriatric patients. The activity was launched at a statewide PCP meeting using a workshop that employed interactive educational strategies (quiz, video analysis, role play). Retrospective “post-post” evaluation focused on workshop processes and outcomes.
Results: Eight PCPs completed the session reporting that at baseline the modal number of conversations PCPs initiated each week about ADs was < 1/week (range 0 to > 10). All participants targeted a minimum 25% increase in AD conversations as the improvement goal. Post workshop evaluation analysis found: 1) improvement among four literature-based barriers to AD discussions in the aggregate of responses; 2) all participants were more likely to initiate conversations with patients about ADs; and 3) 88% (7/8) were “very likely” to recommend the session to a colleague.
Conclusion: Experienced PCPs perceive AD discussions as fraught with barriers. This brief (90 min) interactive AD discussion focused MOC activity minimized perceived barriers and increased primary care physician commitment to increase AD discussions with geriatric patients.