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3,520 medication errors evaluated to assess the potential for IT-based decision support.

https://arctichealth.org/en/permalink/ahliterature133611
Source
Stud Health Technol Inform. 2011;166:31-7
Publication Type
Article
Date
2011
Author
Kristine Binzer
Annemarie Hellebek
Author Affiliation
Unit for Patient Safety, Capital Region of Denmark.
Source
Stud Health Technol Inform. 2011;166:31-7
Date
2011
Language
English
Publication Type
Article
Keywords
Decision Support Systems, Clinical - organization & administration
Denmark
Humans
Information Systems - organization & administration
Medication Errors - classification - statistics & numerical data
Software Design
Abstract
We have previously studied system failures involved in medication errors using a limited number of root cause analyses as source. The aim of this study was to describe a larger number of medication errors with respect to harm, involved medicines and involved system problems - thus providing information for the development of IT-based decision support. We evaluated 3,520 medication error reports derived from 12 months of consecutive reporting from 13 hospitals in the Capital Region of Denmark. We found 0.65% errors with serious harm and 16% with moderate harm. A small number of medicines were involved in the majority of the errors. The problems in the medication error process were heterogeneous. Some were related to specific medicines and others were related to the computerized order entry system. Accordingly decision support targeted at specific medicines and improved IT systems are part of the continuing work to reduce the frequency of medication errors.
PubMed ID
21685608 View in PubMed
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Advanced practice nursing in Canada: overview of a decision support synthesis.

https://arctichealth.org/en/permalink/ahliterature135441
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:15-34
Publication Type
Article
Date
Dec-2010
Author
Alba DiCenso
Ruth Martin-Misener
Denise Bryant-Lukosius
Ivy Bourgeault
Kelley Kilpatrick
Faith Donald
Sharon Kaasalainen
Patricia Harbman
Nancy Carter
Sandra Kioke
Julia Abelson
R James McKinlay
Dianna Pasic
Brandi Wasyluk
Julie Vohra
Renee Charbonneau-Smith
Author Affiliation
Ontario Training Centre in Health Services & Policy Research, Nursing and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON.
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:15-34
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Advanced Practice Nursing - classification - methods - organization & administration
Canada
Decision Support Systems, Clinical - classification - organization & administration
Focus Groups
Health Care Surveys
Health Policy
Humans
Leadership
Nurse Clinicians - classification - organization & administration
Nurse Practitioners - classification - organization & administration
Periodicals as Topic - statistics & numerical data
Publishing - statistics & numerical data
Abstract
The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.
PubMed ID
21478685 View in PubMed
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Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

https://arctichealth.org/en/permalink/ahliterature294693
Source
BMC Med Inform Decis Mak. 2017 12 28; 17(1):181
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-28-2017
Author
Tina Lien Barken
Elin Thygesen
Ulrika Söderhamn
Author Affiliation
Centre for eHealth, Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Post box 422, 4604, Kristiansand, Norway. tina.l.barken@uia.no.
Source
BMC Med Inform Decis Mak. 2017 12 28; 17(1):181
Date
12-28-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Anthropology, Cultural
Clinical Decision-Making - methods
Decision Support Systems, Clinical
Female
Humans
Middle Aged
Norway
Nursing - methods
Pulmonary Disease, Chronic Obstructive - therapy
Qualitative Research
Telemedicine - methods
Abstract
Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated.
In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis.
When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process.
In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.
Notes
Cites: BMJ. 1995 Jul 15;311(6998):182-4 PMID 7613435
Cites: Implement Sci. 2011 Aug 03;6:92 PMID 21824386
Cites: J Am Acad Nurse Pract. 2005 May;17(5):176-80 PMID 15854106
Cites: J Nurs Manag. 2008 Mar;16(2):173-80 PMID 18269548
Cites: J Multidiscip Healthc. 2015 Apr 08;8:189-97 PMID 25914543
Cites: J Adv Nurs. 2005 Sep;51(5):493-501 PMID 16098166
Cites: Nurse Educ Today. 2016 Nov;46:75-80 PMID 27611485
Cites: Int J Med Inform. 2015 Dec;84(12):1009-18 PMID 26391601
Cites: J Clin Nurs. 2003 Sep;12 (5):630-42 PMID 12919209
Cites: J Med Internet Res. 2016 Mar 01;18(3):e53 PMID 26932229
Cites: J Telemed Telecare. 2016 Oct;22(7):422-9 PMID 26541347
Cites: J Adv Nurs. 1994 Apr;19(4):717-24 PMID 8021393
Cites: Respir Med. 2010 Feb;104(2):159-65 PMID 19818590
Cites: Nurs Outlook. 2001 Mar-Apr;49(2):100-5 PMID 11309565
Cites: J Nurs Educ. 2014 Aug;53(8):453-8 PMID 25050560
Cites: Comput Inform Nurs. 2008 May-Jun;26(3):151-8 PMID 18438151
Cites: Patient Educ Couns. 2006 Feb;60(2):102-14 PMID 16442453
Cites: BMJ. 2000 Dec 2;321(7273):1400-2 PMID 11099288
Cites: Health Psychol. 2016 Jan;35(1):60-8 PMID 26148189
Cites: J Transl Med. 2014 Nov 28;12 Suppl 2:S9 PMID 25471545
Cites: J Adv Nurs. 2003 Aug;43(3):310-9 PMID 12859790
Cites: Qual Health Res. 2010 Apr;20(4):565-75 PMID 19959822
Cites: Ann Palliat Med. 2014 Oct;3(4):276-85 PMID 25841907
Cites: J Adv Nurs. 2012 Dec;68(12):2802-15 PMID 22607115
Cites: J Clin Nurs. 2000 Jan;9(1):25-35 PMID 11022489
Cites: J Clin Nurs. 2008 Jan;17(2):187-95 PMID 17331095
Cites: J Am Med Inform Assoc. 2001 Nov-Dec;8(6):527-34 PMID 11687560
Cites: J Clin Nurs. 2008 Sep;17(18):2444-51 PMID 18705724
Cites: Health Place. 2013 May;21:140-7 PMID 23474353
Cites: Nurs Adm Q. 2005 Oct-Dec;29(4):339-43 PMID 16260998
Cites: Nurse Educ Pract. 2008 May;8(3):177-83 PMID 17869587
Cites: J Adv Nurs. 2005 Jan;49(1):68-77 PMID 15610383
Cites: J Nurs Manag. 2008 Sep;16(6):692-9 PMID 18808463
Cites: Int J Nurs Stud. 2013 Dec;50(12):1720-6 PMID 23747201
Cites: Prim Care Respir J. 2012 Sep;21(3):322-8 PMID 22875143
Cites: Nurs Stand. 2011 Nov 23-29;26(12 ):49-56; quiz 58 PMID 22216667
Cites: J Clin Nurs. 2018 Jan;27(1-2):132-142 PMID 28425194
Cites: J Adv Nurs. 2004 Feb;45(3):280-6 PMID 14720245
Cites: Nurse Educ Today. 2004 Feb;24(2):105-12 PMID 14769454
Cites: J Clin Nurs. 2004 Oct;13(7):850-7 PMID 15361158
Cites: J Clin Nurs. 2007 Oct;16(10):1865-71 PMID 17880475
Cites: BMJ. 2005 Apr 2;330(7494):765 PMID 15767266
Cites: J Health Serv Res Policy. 2007 Oct;12(4):242-9 PMID 17925077
Cites: J Clin Nurs. 2009 Apr;18(8):1159-67 PMID 19320785
Cites: J Telemed Telecare. 2017 Jan 1;:1357633X17735558 PMID 28994634
Cites: Chron Respir Dis. 2016 Aug;13(3):264-83 PMID 27097638
Cites: J Nurs Educ. 2006 Jun;45(6):204-11 PMID 16780008
PubMed ID
29282068 View in PubMed
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An implementation study of the PDRD primary care computerized guidelines.

https://arctichealth.org/en/permalink/ahliterature204085
Source
Scand J Prim Health Care. 1998 Sep;16(3):149-53
Publication Type
Article
Date
Sep-1998
Author
J. Jousimaa
I. Kunnamo
M. Mäkelä
Author Affiliation
University of Kuopio, Department of Community Health and General Practice, Finland.
Source
Scand J Prim Health Care. 1998 Sep;16(3):149-53
Date
Sep-1998
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Computer User Training
Databases, Factual
Decision Support Systems, Clinical
Family Practice - education - standards
Female
Finland
Follow-Up Studies
Guideline Adherence
Humans
Male
Middle Aged
Practice Guidelines as Topic
Primary Health Care - standards
Questionnaires
Reference Books
Therapy, Computer-Assisted - organization & administration
Abstract
To study the implementation of electronic guidelines designed for general practitioners (GPs).
A descriptive 3-year follow-up study.
All new subscribers to Physician's Desk Reference and Database (PDRD) in 1992.
Locations of computers, where PDRD software was installed for the first time in 1992.
Expectations of the program and changes in attitudes towards it, getting started with the system, frequency and continuity of use and estimated usefulness of the program.
The guidelines were expected to enhance diagnostic accuracy (60% of subscribers), save time (45%), and reduce costs (11%). After 1 year's use, the opinions of the users on these topics had become slightly more positive. Technical problems delayed starting to use the program in 27%. After 1 year 72% were using the program at least weekly. Using frequency was associated with having the computer in the office. The subscribers who renewed their subscription after one year often became regular users.
The study provides insight into the implementation phase of computer-based guidelines in a population of early adopters. Technical support was essential to overcome the barriers associated with computer technology. The perceived need for information was independent of the age and experience of the physicians.
PubMed ID
9800227 View in PubMed
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Application of the PredictAD decision support tool to a Danish cohort of patients with Alzheimer's disease and other dementias.

https://arctichealth.org/en/permalink/ahliterature259129
Source
Dement Geriatr Cogn Disord. 2014;37(3-4):207-13
Publication Type
Article
Date
2014
Author
A H Simonsen
J. Mattila
A M Hejl
E. Garde
M. van Gils
C. Thomsen
J. Lötjönen
H. Soininen
G. Waldemar
Source
Dement Geriatr Cogn Disord. 2014;37(3-4):207-13
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis
Bayes Theorem
Decision Support Systems, Clinical
Dementia, Vascular - diagnosis
Denmark
Diagnosis, Differential
Female
Frontotemporal Dementia - diagnosis
Humans
Lewy Body Disease - diagnosis
Male
Memory Disorders - diagnosis
Middle Aged
Predictive value of tests
Retrospective Studies
Software
Abstract
The diagnosis of Alzheimer's disease (AD) is based on an ever-increasing body of data and knowledge making it a complex task. The PredictAD tool integrates heterogeneous patient data using an interactive user interface to provide decision support. The aim of this project was to investigate the performance of the tool in distinguishing AD from non-AD dementia using a realistic clinical dataset.
We retrieved clinical data from a group of patients diagnosed with AD (n = 72), vascular dementia (VaD, n = 30), frontotemporal dementia (FTD, n = 25) or dementia with Lewy bodies (DLB, n = 14) at the Copenhagen Memory Clinic at Rigshospitalet. Three classification methods were applied to the data in order to differentiate between AD and a group of non-AD dementias. The methods were the PredictAD tool's Disease State Index (DSI), the naïve Bayesian classifier and the random forest.
The DSI performed best for this realistic dataset with an accuracy of 76.6% compared to the accuracies for the naïve Bayesian classifier and random forest of 67.4 and 66.7%, respectively. Furthermore, the DSI differentiated between the four diagnostic groups with a p value of
PubMed ID
24193095 View in PubMed
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Assessing the sensibility of two clinical decision support systems.

https://arctichealth.org/en/permalink/ahliterature155030
Source
J Med Syst. 2008 Oct;32(5):361-8
Publication Type
Article
Date
Oct-2008
Author
Timothy A D Graham
Michael J Bullard
Andre W Kushniruk
Brian R Holroyd
Brian H Rowe
Author Affiliation
Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada. graham71@gmail.com
Source
J Med Syst. 2008 Oct;32(5):361-8
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Community-Acquired Infections
Decision Support Systems, Clinical - standards
Emergency medical services
Female
Health Care Surveys
Humans
Male
Middle Aged
Neutropenia
Questionnaires
Young Adult
Abstract
Clinicians in Emergency Medicine (EM) are increasingly exposed to guidelines and treatment recommendations. To help access and recall these recommendations, electronic Clinical Decision Support Systems (CDSS) have been developed. This study examined the use and sensibility of two CDSS designed for emergency physicians. CDDS for community acquired pneumonia (CAP) and neutropenic fever (NF) were developed by multidisciplinary teams and have been accessed via an intranet-based homepage (eCPG) for several years. Sensibility is a term coined by Feinstein that describes common sense aspects of a survey instrument. It was modified by emergency researchers to include four main headings: (1) Appropriateness; (2) Objectivity; (3) Content; and (4) Discriminative Power. Sensibility surveys were developed using an iterative approach for both the CAP and NF CDSS and distributed to all 25 emergency physicians at one Canadian site. The overall response rate was 88%. Respondents were 88% male and 83% were less than 40; all were attending EM physicians with specialty designations. A number reported never having used the CAP (21%) or NF (33%) CDSS; 54% (CAP) and 21% (NF) of respondents had used the respective CDSS less than 10 times. Overall, both CDSS were rated highly by users with a mean response of 4.95 (SD 0.56) for CAP and 5.62 (SD 0.62) for NF on a seven-point Likert scale. The majority or respondents (CAP 59%, NF 80%) felt that the NF CDSS was more likely than the CAP CDSS to decrease the chances of making a medical error in medication dose, antibiotic choice or patient disposition (4.61 vs. 5.81, p=0.008). Despite being in place for several years, CDSS for CAP and NF are not used by all EM clinicians. Users were generally satisfied with the CDSS and felt that the NF was more likely than the CAP CDSS to decrease medical errors. Additional research is required to determine the barriers to CDSS use.
PubMed ID
18814492 View in PubMed
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Assistive computing devices: a pilot study to explore nurses' preferences and needs.

https://arctichealth.org/en/permalink/ahliterature166500
Source
Comput Inform Nurs. 2006 Nov-Dec;24(6):328-36
Publication Type
Article
Author
Alex Mihailidis
Laura Krones
Jennifer Boger
Author Affiliation
Intelligent Assistive Technology and Systems Laboratory, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada. alex.mihailidis@utoronto.ca
Source
Comput Inform Nurs. 2006 Nov-Dec;24(6):328-36
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Computers
Clinical Pharmacy Information Systems
Computers, Handheld - utilization
Cross-Sectional Studies
Decision Support Systems, Clinical
Drug Information Services
Drug Therapy - nursing
Drug Therapy, Computer-Assisted
Female
Humans
Needs Assessment
Numerical Analysis, Computer-Assisted
Nursing Methodology Research
Nursing Staff, Hospital - education - psychology
Ontario
Pilot Projects
Qualitative Research
Questionnaires
Reminder Systems
Safety Management
Abstract
Healthcare errors among nurses are common because of the fast-paced work environment, in which extensive data must be analyzed and quick decision making is required. Assistive computing devices can help reduce nursing errors by providing timely access to client information and by assisting nurses with client monitoring, decision making, and bedside documentation. The purpose of this pilot study was to determine what assistive computing device features, functions, and input/output modalities nurses would find most useful as support for their nursing duties. Twenty nurses completed a questionnaire that examined their needs and preferences. Data analysis revealed a strong desire for capabilities related to facilitating information access and administering safe medication. The results of this study will be used to develop design criteria for an assistive computing device that will aim to improve the performance of nurses through appropriate information and data support.
PubMed ID
17108752 View in PubMed
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Awareness and use of the Ottawa ankle and knee rules in 5 countries: can publication alone be enough to change practice?

https://arctichealth.org/en/permalink/ahliterature195632
Source
Ann Emerg Med. 2001 Mar;37(3):259-66
Publication Type
Article
Date
Mar-2001
Author
I D Graham
I G Stiell
A. Laupacis
L. McAuley
M. Howell
M. Clancy
P. Durieux
N. Simon
J I Emparanza
J R Aginaga
A. O'connor
G. Wells
Author Affiliation
Department of Medicine, Faculty of Medicine, University of Ottawa, Canada. igraham@lri.ca
Source
Ann Emerg Med. 2001 Mar;37(3):259-66
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Adult
Ankle Injuries - radiography
Attitude of Health Personnel
Awareness
Canada
Critical Pathways
Cross-Cultural Comparison
Data Collection
Decision Support Systems, Clinical
Diffusion of Innovation
Europe
Female
Humans
Knee Injuries - radiography
Male
Middle Aged
Publishing
United States
Abstract
We evaluate the international diffusion of the Ottawa Ankle and Knee Rules and determine emergency physicians' attitudes toward clinical decision rules in general.
We conducted a cross-sectional, self-administered mail survey of random samples of 500 members each of the American College of Emergency Physicians, Canadian Association of Emergency Physicians, British Association for Accident and Emergency Medicine, Spanish Society for Emergency Medicine, and all members (n=1,350) of the French Speaking Society of Emergency Physicians, France. Main outcome measures were awareness of the Ottawa Ankle and Knee Rules, reported use of these rules, and attitudes toward clinical decision rules in general.
A total of 1,769 (57%) emergency physicians responded, with country-specific response rates between 49% (United States and France) and 79% (Canada). More than 69% of physicians in all countries, except Spain, were aware of the Ottawa Ankle Rules. Use of the Ottawa Ankle Rules differed by country with more than 70% of all responding Canadian and United Kingdom physicians reporting frequent use of the rules compared with fewer than one third of US, French, and Spanish physicians. The Ottawa Knee Rule was less well known and less used by physicians in all countries. Most physicians in all countries viewed decision rules as intended to improve the quality of health care (>78%), a convenient source of advice (>67%), and good educational tools (>61%). Of all physicians, those from the United States held the least positive attitudes toward decision rules.
This constitutes the largest international survey of emergency physicians' attitudes toward and use of clinical decision rules. Striking differences were apparent among countries with regard to knowledge and use of decision rules. Despite similar awareness in the United States, Canada, and the United Kingdom, US physicians appeared much less likely to use the Ottawa Ankle Rules. Future research should investigate factors leading to differences in rates of diffusion among countries and address strategies to enhance dissemination and implementation of such rules in the emergency department.
PubMed ID
11223761 View in PubMed
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Barriers and facilitators influencing call center nurses' decision support for callers facing values-sensitive decisions: a mixed methods study.

https://arctichealth.org/en/permalink/ahliterature167025
Source
Worldviews Evid Based Nurs. 2005;2(4):184-95
Publication Type
Article
Date
2005
Author
Dawn Stacey
Ian D Graham
Annette M O'Connor
Marie-Pascale Pomey
Author Affiliation
University of Ottawa, School of Nursing, Ottawa, Ontario, Canada. dstacey@uottawa.ca
Source
Worldviews Evid Based Nurs. 2005;2(4):184-95
Date
2005
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Clinical Competence
Communication Barriers
Consultants
Decision Support Systems, Clinical - utilization
Decision Support Techniques
Evidence-Based Medicine - education
Health Care Surveys
Hotlines
Humans
Nurses - psychology - standards
Patient Education as Topic
Quality of Health Care
Social Values
Triage
Abstract
Call center nurses triage symptoms and provide health information. However, information alone is not adequate for people facing values-sensitive health decisions. For these decisions, effective interventions are evidence-based patient decision aids and in-person nurse coaching using a structured process. Little is known about the quality of decision support provided by call center nurses.
To identify the barriers and facilitators influencing the provision of decision support by call center nurses to callers facing values-sensitive health decisions at a Canadian province-wide health call center.
A mixed qualitative and quantitative descriptive study from December 2003 to January 2004 using key informant interviews (n= 4), two focus groups (n= 7), a barriers assessment survey (n= 57), and analysis of simulated patient calls (n= 38) were carried out. Triangulation of these data was conducted using a conceptual content analysis method.
Participants indicated positive attitudes toward call center nurses preparing callers facing values-sensitive decisions. Facilitators included decision support resources, nurses' ability to recognize callers having difficulty, and having a supportive organizational infrastructure. The most frequently identified barriers were (a) limited usability of patient decision aids via telephone; (b) lack of a structured process to guide nurses during these types of calls; (c) nurses' inadequate knowledge, skills, and confidence in providing values-sensitive decision support; (d) unclear program direction; (e) organizational pressure to minimize call length; and (f) low public awareness of the services.
Despite call center nurses having positive attitudes, several modifiable barriers were interfering with nurses' current approaches to supporting callers facing values-sensitive decisions. Nurses wanted educational opportunities to further develop their decision support knowledge and skills, and decision support resources that are easier to use via telephone. As well, changes to organizational policies that address identified barriers could further facilitate the provision of decision support.
PubMed ID
17040526 View in PubMed
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Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol.

https://arctichealth.org/en/permalink/ahliterature121904
Source
BMC Med Inform Decis Mak. 2012;12:85
Publication Type
Article
Date
2012
Author
Anik Giguere
Michel Labrecque
Roland Grad
Michel Cauchon
Matthew Greenway
France Légaré
Pierre Pluye
Stephane Turcotte
Lisa Dolovich
R Brian Haynes
Author Affiliation
Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4?K1, Canada. anikgiguere@videotron.ca
Source
BMC Med Inform Decis Mak. 2012;12:85
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Decision Support Systems, Clinical - organization & administration - utilization
Diffusion of Innovation
Health Knowledge, Attitudes, Practice
Humans
Interviews as Topic
Models, organizational
Organizational Culture
Patient care team
Primary Health Care - manpower
Professional-Patient Relations
Qualitative Research
Questionnaires
Regression Analysis
Social Facilitation
Abstract
Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.
A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians' intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians' access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.
This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.
Notes
Cites: Can J Nurs Res. 2004 Jun;36(2):89-10315369167
Cites: Implement Sci. 2012;7:7222862935
Cites: J Nurs Care Qual. 2004 Jan-Mar;19(1):18-24; quiz 25-614717144
Cites: Br J Gen Pract. 2005 Jan;55(510):6-1315667759
Cites: Patient Educ Couns. 2006 Mar;60(3):301-1216051459
Cites: Health Expect. 2007 Dec;10(4):364-7917986073
Cites: Patient Educ Couns. 2008 Dec;73(3):526-3518752915
Cites: Patient Educ Couns. 2009 Apr;75(1):37-5219036550
Cites: Cochrane Database Syst Rev. 2010;(5):CD00673220464744
Cites: J Interprof Care. 2011 Jan;25(1):18-2520795835
Cites: J Eval Clin Pract. 2010 Dec;16(6):1236-4320722882
Cites: Implement Sci. 2011;6:521241514
Cites: Health Expect. 2011 Mar;14 Suppl 1:96-11020629764
Cites: BMC Health Serv Res. 2011;11:2321281487
Cites: BMC Med Inform Decis Mak. 2011;11:1721385470
Cites: J Eval Clin Pract. 2011 Aug;17(4):554-6420695950
Cites: Cochrane Database Syst Rev. 2011;(10):CD00143121975733
Cites: Soc Sci Med. 1999 Sep;49(5):651-6110452420
PubMed ID
22867107 View in PubMed
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169 records – page 1 of 17.