scholarly journals Regulatory focus affects physician risk tolerance

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Peter J. Veazie ◽  
Scott McIntosh ◽  
Benjamin P. Chapman ◽  
James G. Dolan
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Regulatory Focus ◽  
Primary Care Physicians ◽  
Randomization Test ◽  
Practice Variation ◽  
Risk Tolerance ◽  
Medical Decision ◽  
Test Results ◽  
Physician Decision Making

Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention – regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention-focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention-focused manipulation (P=0.01). The Cohen’s d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (P=0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor.

scholarly journals Medical decision making among patients with heart failure – does migration background matter?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Olaf von dem Knesebeck ◽  
Martin Scherer ◽  
Gabriella Marx ◽  
Sarah Koens
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Migration Background ◽  
Disease Stage ◽  
Medical Decision ◽  
Diagnosis And Management ◽  
Migration History

Abstract Background Some studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany? Methods A factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy. Results Analyses revealed no statistically significant differences (p < 0.05), but a consistent tendency: Primary care doctors more often asked lifestyle and psychosocial questions, they more often diagnosed HF, they gave more advice to rest and how to behave in case of deterioration, they more often auscultated the lung, and more often referred to a specialist when the patient has a Turkish migration history compared to a non-migrant patient. Differences in the medical decisions between the two groups ranged between 1.6 and 15.8%. In 10 out of 12 comparisons, differences were below 10%. Conclusions Our results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.

scholarly journals Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023832 ◽  
Author(s):  
David Silvério Rodrigues ◽  
Paulo Faria Sousa ◽  
Nuno Basílio ◽  
Ana Antunes ◽  
Maria da Luz Antunes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Qualitative Research ◽  
Primary Care Physicians ◽  
Medical Decision ◽  
Published Data ◽  
Qualitative Evidence Synthesis ◽  
Thematic Synthesis ◽  
Qualitative Evidence

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.

Primary care physicians’ medical decision making for late-life depression

1996 ◽  
Vol 11 (4) ◽  
pp. 218-225 ◽  
Author(s):  
Christopher M. Callahan ◽  
Robert S. Dittus ◽  
William M. Tierney
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Late Life ◽  
Medical Decision ◽  
Late Life Depression

scholarly journals Personalized treatment options for chronic diseases using precision cohort analytics

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenney Ng ◽  
Uri Kartoun ◽  
Harry Stavropoulos ◽  
John A. Zambrano ◽  
Paul C. Tang
Keyword(s):  
Decision Making ◽  
Chronic Diseases ◽  
Primary Care Physicians ◽  
Treatment Guidelines ◽  
Point Of Care ◽  
Data Extraction ◽  
Treatment Options ◽  
Personalized Treatment ◽  
Medical Decision ◽  
Similarity Model

AbstractTo support point-of-care decision making by presenting outcomes of past treatment choices for cohorts of similar patients based on observational data from electronic health records (EHRs), a machine-learning precision cohort treatment option (PCTO) workflow consisting of (1) data extraction, (2) similarity model training, (3) precision cohort identification, and (4) treatment options analysis was developed. The similarity model is used to dynamically create a cohort of similar patients, to inform clinical decisions about an individual patient. The workflow was implemented using EHR data from a large health care provider for three different highly prevalent chronic diseases: hypertension (HTN), type 2 diabetes mellitus (T2DM), and hyperlipidemia (HL). A retrospective analysis demonstrated that treatment options with better outcomes were available for a majority of cases (75%, 74%, 85% for HTN, T2DM, HL, respectively). The models for HTN and T2DM were deployed in a pilot study with primary care physicians using it during clinic visits. A novel data-analytic workflow was developed to create patient-similarity models that dynamically generate personalized treatment insights at the point-of-care. By leveraging both knowledge-driven treatment guidelines and data-driven EHR data, physicians can incorporate real-world evidence in their medical decision-making process when considering treatment options for individual patients.

How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas

2017 ◽  
Vol 27 (2) ◽  
pp. 158-166 ◽  
Author(s):  
Diana N. Carvajal ◽  
Deborah Gioia ◽  
Estefania Rivera Mudafort ◽  
Pamela Bohrer Brown ◽  
Beth Barnet
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Primary Care Physicians

scholarly journals Factors affecting general practitioners’ choice of drug therapy: A study in primary healthcare in Iceland

2021 ◽  
Vol 107 (11) ◽  
pp. 522-527
Author(s):  
Yrsa Ívarsdóttir ◽  
◽  
Jón Steinar Jónsson ◽  
Kristján Linnet ◽  
Anna Bryndís Blöndal ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Drug Interaction ◽  
Drug Therapy ◽  
Primary Care Physicians ◽  
New Drugs ◽  
Factors Affecting ◽  
Face To Face ◽  
Software Information ◽  
Strongly Agree

Introduction: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions. Material and methods: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel. Results: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software. Conclusion: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients’ drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists.

Sign in / Sign up

Export Citation Format

Share Document