scholarly journals Clinical pathways for primary care: current use, interest and perceived usability

2018 ◽  
Vol 25 (7) ◽  
pp. 901-906 ◽  
Author(s):  
Jennifer M Toy ◽  
Adam Drechsler ◽  
Richard C Waters
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Clinical Pathways ◽  
Decision Support Tool ◽  
Daily Practice ◽  
Support Tool ◽  
System Usability Scale ◽  
Primary Care Clinicians ◽  
Perceived Usability ◽  
Tool Types

Abstract Objective Translating clinical evidence to daily practice remains a challenge and may improve with clinical pathways. We assessed interest in and usability of clinical pathways by primary care professionals. Methods An online survey was created. Interest in pathways for patient care and learning was assessed at start and finish. Participants completed baseline questions then pathway-associated question sets related to management of 2 chronic diseases. Perceived pathway usability was assessed using the system usability scale. Accuracy and confidence of answers was compared for baseline and pathway-assisted questions. Results Of 115 participants, 17.4% had used clinical pathways, the lowest of decision support tool types surveyed. Accuracy and confidence in answers significantly improved for all pathways. Interest in using pathways daily or weekly was above 75% for the respondents. Conclusion There is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions.

scholarly journals Primary Care Clinicians Attitudes and Knowledge of Pharmacogenetics in a Large, Multi-state, Healthcare System

2018 ◽  
Vol 9 (2) ◽  
pp. 6
Author(s):  
Megan Olander ◽  
Stephen Waring ◽  
David D Stenehjem ◽  
Allise Taran ◽  
Paul L Raneli ◽  
...  
Keyword(s):  
Primary Care ◽  
Conflicts Of Interest ◽  
Human Subjects ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Primary Objective ◽  
Pharmacogenetic Testing ◽  
Support Tool ◽  
Medication Therapy ◽  
Primary Care Clinicians

  Background: Considerable progress has been made in the way of pharmacogenetic research and the development of clinical recommendations; however, its implementation into clinical practice has been slower than anticipated. We sought to better understand its lack of clinical uptake within primary care. Aim: The primary objective of this survey was to ascertain primary care clinicians’ perceptions of pharmacogenetic use and implementation in an integrated health system of metropolitan and rural settings across several states. Methods: Primary care clinicians (including MDs, DOs, NPs, and PAs) were invited to participate in a survey via email. Questions about pharmacogenetics knowledge and perceptions were presented to assess current understanding and usage of pharmacogenetics in practice. Results: The rate of response for the survey was 17%. Of the 90 respondents, 58% were female, 69% were MDs/DOs, 20% were NPs, and 11% were PAs. Fifty-eight percent of respondents received their clinical degree in or after 2000. Ninety percent of respondents noted that they were uncomfortable ordering a pharmacogenetics test, with 76% stating they were uncomfortable applying the results of a pharmacogenetic test. Notably, 78% of respondents were interested in having pharmacogenetic testing available through Medication Therapy Management (MTM) services, although PAs were significantly less interested as compared to NPs and MD/DOs. Ninety-five percent of respondents were interested in a clinical decision support tool relevant to pharmacogenetic results. Conclusions: As a whole, prescribing clinicians in primary care clinics are uncomfortable in the ordering, interpreting, and applying pharmacogenetic results to individual patients. However, favorable attitudes towards providing pharmacogenetic testing through existing MTM clinics provides the opportunity for pharmacists to advance existing practices. Conflict of Interest: We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties Treatment of Human Subjects: IRB determined project was non-HSR   Type: Student Project

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

scholarly journals PRImary care Management of lower Urinary tract Symptoms in men: protocol for development and validation of a diagnostic and clinical decision support tool (the PriMUS study)

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037634
Author(s):  
Bethan Pell ◽  
Emma Thomas-Jones ◽  
Alison Bray ◽  
Ridhi Agarwal ◽  
Haroon Ahmed ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Urinary Tract Symptoms ◽  
Primary Care Management ◽  
Lower Urinary

IntroductionLower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology specialists who often recommend treatments that could have been initiated in primary care. GP access to simple, accurate tests and clinician decision tools are needed to facilitate accurate and effective patient management of LUTS in primary care.Methods and analysisPRImary care Management of lower Urinary tract Symptoms (PriMUS) is a prospective diagnostic accuracy study based in primary care. The study will determine which of a number of index tests used in combination best predict three urodynamic observations in men who present to their GP with LUTS. These are detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity. Two cohorts of participants, one for development of the prototype diagnostic tool and other for validation, will undergo a series of simple index tests and the invasive reference standard (invasive urodynamics). We will develop and validate three diagnostic prediction models based on each condition and then combine them with management recommendations to form a clinical decision support tool.Ethics and disseminationEthics approval is from the Wales Research Ethics Committee 6. Findings will be disseminated through peer-reviewed journals and conferences, and results will be of interest to professional and patient stakeholders.Trial registration numberISRCTN10327305.

scholarly journals Preflight Weather Decision Support Tool (PWDST): User-Centered Design Process and Usability Validation

2019 ◽  
Vol 63 (1) ◽  
pp. 1915-1919
Author(s):  
Jayde King ◽  
John Kleber ◽  
Ashlee Harris ◽  
Barbara Chaparro ◽  
Beth Blickensderfer
Keyword(s):  
Decision Support ◽  
Design Process ◽  
Decision Support Tool ◽  
General Aviation ◽  
Future Research ◽  
User Centered Design ◽  
Accident Rate ◽  
Support Tool ◽  
Perceived Usability ◽  
User Centered

General Aviation flight operations have been negatively affected by the slow decreasing weather related accident rate for the last 20 years. Upon further investigation, research suggests, that poor preflight planning and a lack of aviation weather experience and knowledge may be contributing factors to the stagnant weather related accident rate. Our team developed a Preflight Weather Decision Support Tool (PWDST) to help novice pilots access, interpret, and apply weather information. We used a user-centered design process which involved an initial task analysis, low-fidelity prototyping, low-fidelity usability testing, user interviews and expert review. This study assessed and compared the perceived usability, difficulty, and the system assistance satisfaction of the PWDST. Participants (n=9) completed a usability study and a series of surveys during, as well as, after the completion of the preflight planning scenario. A series of Mann-Whitney U Tests were conducted to compare the difference between Private Pilot and Certified Flight Instructors (CFI) perceived usability, difficulty, and system assistance satisfaction ratings. Results indicated, there were no significant differences between group ratings. Overall, both groups reported above average usability, system assistance and low difficulty rating for the PWDST. Future research and possible implications are discussed.

scholarly journals PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents

2018 ◽  
Vol 3 (Suppl 5) ◽  
pp. e000957 ◽  
Author(s):  
Sandy Picken ◽  
Juliet Hannington ◽  
Lara Fairall ◽  
Tanya Doherty ◽  
Eric Bateman ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Low Income ◽  
Integrated Management ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Childhood Mortality ◽  
Middle Income ◽  
Support Tool

Pioneering strategies like WHO’s Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.

Integration of a clinical pathways software into an EHR in a large, multisite, hospital-affiliated community oncology setting.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 129-129
Author(s):  
Corey J. Shamah ◽  
Thomas James Saphner ◽  
Jacob C. Frick ◽  
Carol Huibregtse ◽  
Gail S. Stiemke
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Patient Information ◽  
Clinical Pathways ◽  
Capture Rate ◽  
Treatment Algorithm ◽  
Decision Support Tool ◽  
Subsequent Increase ◽  
Decision Algorithm ◽  
Support Tool

129 Background: Via Oncology (Via) is a decision support tool that integrates patient information, their disease, and goals of care to develop a treatment algorithm. Via prioritizes treatments by efficacy first, toxicity second, and cost third. The recommended regimen is offered to the doctor and patient who may accept it or choose an off pathway treatment. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost. Physicians are often unaware that a trial is available for a patient and EHR’s are not commonly used to facilitate accrual to clinical trials. A pathway system could also alert doctors to the availability of a clinical trial and is designed to increase accrual to clinical trials. Methods: The integration of Via into the Epic EHR was facilitated by 3 major interfaces: patient information sent from the EHR to Via, the providers’ schedules sent from the EHR to Via, and the protocol selected in Via sent back to the EHR. Within the decision algorithm, clinical trials were recommended as the first option in all lines of therapy when available. Results: After 11 months and 103,515 visits, the visit capture rate was 82.7%%. With 3,844 decisions made, 83.9% of all treatment decisions were on pathway. Clinical trial enrollment was 122 patients in the 459 days prior to Via implementation, and 102 patients in the 271 days afterwards. This increase in accrual rate was significant (p = 0.00174.) Conclusions: The pathway program was rapidly accepted by physicians and the recommendations were commonly accepted. The subsequent increase in clinical accrual, while not definitive of causation, is promising. An upgrade of the Epic EHR is planned in the near future. A single log in to open Via and the EHR concomitantly is planned. An additional interface to bring staging information from the EHR to Via is being planned.

scholarly journals Attitudes towards Trusting Artificial Intelligence Insights and Factors to Prevent the Passive Adherence of GPs: A Pilot Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3101
Author(s):  
Massimo Micocci ◽  
Simone Borsci ◽  
Viral Thakerar ◽  
Simon Walne ◽  
Yasmine Manshadi ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Domain Knowledge ◽  
Online Survey ◽  
Decision Support Tool ◽  
Skin Lesions ◽  
Management Plan ◽  
Individual Characteristics ◽  
System Efficiency ◽  
Support Tool ◽  
The Difference

Artificial Intelligence (AI) systems could improve system efficiency by supporting clinicians in making appropriate referrals. However, they are imperfect by nature and misdiagnoses, if not correctly identified, can have consequences for patient care. In this paper, findings from an online survey are presented to understand the aptitude of GPs (n = 50) in appropriately trusting or not trusting the output of a fictitious AI-based decision support tool when assessing skin lesions, and to identify which individual characteristics could make GPs less prone to adhere to erroneous diagnostics results. The findings suggest that, when the AI was correct, the GPs’ ability to correctly diagnose a skin lesion significantly improved after receiving correct AI information, from 73.6% to 86.8% (X2 (1, N = 50) = 21.787, p < 0.001), with significant effects for both the benign (X2 (1, N = 50) = 21, p < 0.001) and malignant cases (X2 (1, N = 50) = 4.654, p = 0.031). However, when the AI provided erroneous information, only 10% of the GPs were able to correctly disagree with the indication of the AI in terms of diagnosis (d-AIW M: 0.12, SD: 0.37), and only 14% of participants were able to correctly decide the management plan despite the AI insights (d-AIW M:0.12, SD: 0.32). The analysis of the difference between groups in terms of individual characteristics suggested that GPs with domain knowledge in dermatology were better at rejecting the wrong insights from AI.

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