scholarly journals The Influence of Non-Clinical Patient Factors on Clinical Decision Making: Uncovering the Impact on Mental Health

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Lauren Burns ◽  
Ana Sergio da Silva ◽  
Ann John
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Short Form ◽  
Clinical Decision ◽  
Patient Factors ◽  
Clinical Patient ◽  
Referral Decisions ◽  
Sf36 Score ◽  
The Impact

BackgroundUnderstanding how non-clinical patient factors (NCpF) such as gender, educational level and socioeconomic status impact clinical decisions regarding one’s mental health is important for appropriate and equitable care. Main AimThis research aims to i) investigate the feasibility of using administrative health data to investigate clinical decision making in mental health; ii) understand the impact of NCpF on mental health-related diagnosis, treatment, and referral decisions. Methods/ApproachThree waves of the Welsh Health Survey, containing a five-item Mental Health Inventory (Short- Form SF36), and NCpF information were used to create our interest cohort. The records with a low SF36, a ‘gold standard’ identifier of common mental health conditions, were then linked to the healthcare records datasets (Primary Care GP Dataset, Patient Episode Database for Wales, Emergency Department Dataset, Outpatient Referral Dataset, Annual District Death Extract) securely stored on the Secure Anonymised Information Linkage Databank. ResultsWe will present the methodological challenges and benefits of using administrative data the study of decision making in mental health. The differences in NCpF between those with a low SF36 and a mental health diagnosis, symptoms and treatment as well as those with a similar SF36 score but no diagnosis, symptoms or treatment recorded will be presented and discussed. ConclusionAdministrative data can provide a unique opportunity to investigate issues related with clinical decision-making in mental health and improve health equity. Having a better understanding of the influence of NCpF on mental health decisions is necessary to prevent inequity in mental health care.

scholarly journals Paramedic experiences of providing care in wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048677
Author(s):  
Nigel Rees ◽  
Lauren Smythe ◽  
Chloe Hogan ◽  
Julia Williams
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Grounded Theory ◽  
Qualitative Study ◽  
Health Services ◽  
Clinical Decision Making ◽  
Social Process ◽  
Well Being ◽  
Clinical Decision ◽  
The Impact

ObjectiveTo explore paramedic experiences of providing care during the 2020 COVID-19 pandemic and develop theory in order to inform future policy and practice.DesignQualitative study using constructivist evolved grounded theory (EGT) methodology. One-to-one semistructured interviews were conducted using a general interview guide. Voice over Internet Protocol was used through Skype.SettingConducted between March 2020 and November 2020 in the Welsh Ambulance Services National Health Services Trust UK which serves a population of three million.ParticipantsParamedics were recruited through a poster circulated by email and social media. Following purposive sampling, 20 Paramedics were enrolled and interviewed.ResultsEmergent categories included: Protect me to protect you, Rapid disruption and adaptation, Trust in communication and information and United in hardship. The Basic Social Process was recognised to involve Tragic Choices, conceptualised through an EGT including Tragic personal and professional choices including concerns over personnel protective equipment (PPE), protecting themselves and their families, impact on mental health and difficult clinical decisions, Tragic organisational choices including decision making support, communication, mental health and well-being and Tragic societal choices involving public shows of support, utilisation and resourcing of health services.ConclusionsRich insights were revealed into paramedic care during the COVID-19 pandemic consistent with other research. This care was provided in the context of competing and conflicting decisions and resources, where Tragic Choices have to be made which may challenge life’s pricelessness. Well-being support, clinical decision making, appropriate PPE and healthcare resourcing are all influenced by choices made before and during the pandemic, and will continue as we recover and plan for future pandemics. The impact of COVID-19 may persist, especially if we fail to learn, if not we risk losing more lives in this and future pandemics and threatening the overwhelming collective effort which united society in hardship when responding to the COVID-19 Pandemic.Trial registration numberIRAS ID: 282 623.

scholarly journals Correction to: Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Briana S. Last ◽  
Simone H. Schriger ◽  
Carter E. Timon ◽  
Hannah E. Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Qualitative Study ◽  
Clinical Decision Making ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Mental Health Settings

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units

2014 ◽  
Vol 11 (02) ◽  
pp. 105-118 ◽  
Author(s):  
Karleen Gwinner ◽  
Louise Ward
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Intensive Care ◽  
Lived Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Review Of Literature ◽  
Psychiatric Distress ◽  
Nurse Knowledge

AbstractBackground and aimIn recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.MethodData gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.ResultsFour defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.ConclusionThe four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

AAC Assessment and Clinical-Decision Making: The Impact of Experience

2012 ◽  
Vol 28 (3) ◽  
pp. 148-159 ◽  
Author(s):  
Aimee Dietz ◽  
Wendy Quach ◽  
Shelley K. Lund ◽  
Miechelle McKelvey
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Impact

scholarly journals Probability and loss: two sides of the risk assessment coin

2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Current Form ◽  
Mental Health Settings ◽  
Future Harm ◽  
Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P < .001) and ease of finding information for clinical decision making (r = 0.663, P < .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

scholarly journals Clinicians’ experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Carlisle ◽  
H. A. Watson ◽  
J. Carter ◽  
K. Kuhrt ◽  
P. T. Seed ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Cultural Context ◽  
Clinical Decision Making ◽  
Qualitative Interviews ◽  
Scale Up ◽  
Clinical Decision ◽  
Clinical Trial Registry ◽  
Support Tool ◽  
The Impact

Abstract Background As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. Methods Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians’ (obstetricians’ and midwives’) experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. Results Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: ‘experience of using the app’, ‘how QUiPP risk changes practice’ and ‘successfully adopting QUiPP: context is everything’. With these final themes we appeared to have achieved our aim of exploring the clinicians’ experiences of using and implementing the QUiPP app. Conclusion This study explored different clinician’s experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. Clinical trial registry and registration number ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337.

scholarly journals Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

2020 ◽  
Author(s):  
Philip Scott ◽  
Elisavet Andrikopoulou ◽  
Haythem Nakkas ◽  
Paul Roderick
Keyword(s):  
Decision Making ◽  
Health Information ◽  
Information Exchange ◽  
Healthcare Professionals ◽  
Clinical Decision Making ◽  
Social Care ◽  
Health Information Exchange ◽  
Clinical Decision ◽  
Health And Social Care ◽  
The Impact

Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

Mental Health Clinical Decision Support Exploiting Big Data

2019 ◽  
pp. 160-184 ◽  
Author(s):  
Jan Kalina
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Big Data ◽  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Clinical Decision Making ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision

The complexity of clinical decision-making is immensely increasing with the advent of big data with a clinical relevance. Clinical decision systems represent useful e-health tools applicable to various tasks within the clinical decision-making process. This chapter is devoted to basic principles of clinical decision support systems and their benefits for healthcare and patient safety. Big data is crucial input for clinical decision support systems and is helpful in the task to find the diagnosis, prognosis, and therapy. Statistical challenges of analyzing big data in psychiatry are overviewed, with a particular interest for psychiatry. Various barriers preventing telemedicine tools from expanding to the field of mental health are discussed. The development of decision support systems is claimed here to play a key role in the development of information-based medicine, particularly in psychiatry. Information technology will be ultimately able to combine various information sources including big data to present and enforce a holistic information-based approach to psychiatric care.

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