The Differences Of Shared Decision Making Of Patients With Chronic Disease In The Online And In The Offline And Effect On Medication Compliance

[Purpose]In the setting of rapid increase of chronic diseases bringing a series of drug safety problems,shared decision making(SDM)has become the trend of medical decision-making.There is a lack of comparative study about SDM in the online and offline,and study on the effect of SDM on medication compliance.This study is aim to determine the level and differences of chronic disease patients’SDM,and SDM models affecting patients’medication compliance in the online and offline.[Methods]In this study,we first used strict criteria to summarize the researches on SDM and medication safety.Measuring tool of SDM in web-based pharmaceutical care consulation developed by Chen Haihong was used to design a questionnaire for100 patient with chronic diseases.Paired sample nonparametric test was used to analyse the differences of the overall situation of SDM,the differences in every dimension and measurement index in the online and offline.Multiple linear regression analysis was used to analyse the influence of the basic information of survey objects on SDM.Partial Least Squares Structural Equation Modeling(PLS-SEM)was used to construct models of the influences of SDM on medication compliance.[Results](1)The total points was 71.25 in the online and 73-81 in the offline(full mark was 95),“Comprehensive understanding the patient’s condition”was 37.3 and38.88(50),“Exchanging ideas on medication option”was 11.18 and 11.68(full mark was 15),“Achieving a medication plan”was 15.14 and 15.37(full mark was 20),and“Providing decision support”was 7.63 and 7.88(full mark was 10).The total point of SDM was high,and the point in the online was higher than that in the offline(p<0.05).The full mark for every item was 5.Mean value of 19 items in the online was on a scale of 3.5 to 4.Mean value of three of 19 items in the online was more than 4,Mean value of the other 16 items was on a scale of 3.5 to 4.(2)There was a significant difference for“health status”to SDM scores(p<0.05).The better the"health",the higher the SDM scores.The SDM scores of"remote rural"were lower than that of“first-tier cities”in the online.And there was a significant difference between them(p<0.05).The SDM scores of"remote rural"were lower than that of“first-tier cities”in the offline.And there was a significant difference between them(p<0.05).However,“health status”had no significant effect on SDM scores in the offline(p>0.05),which was different from that in the online.(3)Whether in the online or in the offline,“Comprehensive understanding the patient’s condition”to“Exchanging ideas on medication option”,“Exchanging ideas on medication option”to“Achieving a medication plan”,“Providing decision support”to“Exchanging ideas on medication option”,“Providing decision support”to“Achieving a medication plan”and“Achieving a medication plan”to“Medication compliance”.There was a significant difference for path coefficient(p<0.05)).At the same time,R~2,rectificatus R~2 andf2 passed the verification,too(R~2>0.8,rectificatus R~2>0.8,f~2>0.02).[Conclusions]SDM level was lower than that in the same type of researches,and needed to be improved.The scores in offline was higher than that in online.Main effective factors for the level of SDM were“health status”and“residence”.The model validated“Comprehensive understanding the patient’s condition”to“Exchanging ideas on medication option”,“Exchanging ideas on medication option”to“Achieving a medication plan”,“Providing decision support”to“Exchanging ideas on medication option”,“Providing decision support”to“Achieving a medication plan”and“Achieving a medication plan”to“Medication compliance”.[Innovation and Limitation]For the innovation,first,reliable SDM scales were used to measure SDM in the online and in the offline.The application scenario and evidence-based evidence were enriched.Second,the models of the effect of SDM on medication compliance were constructed,which provided the guiding framework or policy basis for the effect of SDM on medication compliance.For the limitation,first,some of the respondents had not experienced online medical treatment,but were familiar with it.Some of their friends and relatives had relative experiences.Second,The sample size was relatively small and would be further increased in the later period.And respondents would be strictly admitted.Third,The SDM in the online did not reflect“health literacy”,“self-efficacy”and other factors,and Many results cannot be explained by“good”or“bad”.