Increasing the Number of Patients with Advance Directive in a Primary Care Clinic

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Kincaid, Kathleen
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Purpose: The purpose of this quality improvement project was to implement standardized educational tools to increase patient and healthcare provider knowledge regarding advance directives (AD) and to implement a standardized AD tool for use by all patients 65 years of age and older in a primary care clinic. Only 19% of patients had an advance directive discussion with the provider at this clinic prior to this project implementation.|Background: Advance directives allow patients to feel some form of control and autonomy regarding their heath, even in cases where they cannot verbalize their own decisions. Research shows ADs decrease healthcare costs and improve patient and family satisfaction, especially during end-of-life situations. However, less than 30% of patients 65 years of age and older in the United States have an AD. Sample/Setting: The rural primary care clinic serves approximately 374 patients who are 65 years of age and older.|Methods: Standardized education was given to patients 65 years of age and older who were seeing their primary care provider at the clinic for chronic care needs throughout the span of four months. The information guide and the Advance Directive form from Honoring Choices Idaho was discussed with patients who met criteria and provided to them to take home. An Idaho Physician Order for Scope of Treatment (POST) form was also supplied. Patients were asked to bring the forms back to the clinic once they were filled out.|Results: Throughout the 4-month time span, 64 of the 83 patients (77.1%) who met inclusion criteria had an advance directive discussion with the provider and were provided the standardized teaching. Of those 64 patients, 32 (50%) implemented an advance directive at the clinic. Conclusion: This project demonstrated that increased education and provision of adequate resources increased the number of patients who are 65 years of age and older at a primary clinic with ADs.
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