Decision-Making Processes of Patients Who Use the Emergency Department for Primary Care Needs

2013 ◽  
Vol 24 (3) ◽  
pp. 1288-1305 ◽  
Author(s):  
Eric K. Shaw ◽  
Jenna Howard ◽  
Elizabeth C. Clark ◽  
Rebecca S. Etz ◽  
Rajiv Arya ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Emergency Department ◽  
Care Needs ◽  
Decision Making Processes

scholarly journals P140: Emergency department decision-making for incapacitated and unrepresented patients: a comprehensive review of the literature

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S124-S125
Author(s):  
J.L. Willinsky ◽  
I. Hyun
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Medical Decision Making ◽  
Hospital Setting ◽  
Ethics Committees ◽  
Medical Decision ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Patient Cohort ◽  
Decision Making Processes

Introduction: Incapacitated patients who lack substitute decision-makers (SDM) are commonly encountered in the emergency department (ED). The number of these patients will rise dramatically as the Baby Boomers age. We can expect an influx of elderly patients who lack decisional capacity due to dementia and other illnesses, and who present without family. It is estimated that 3 to 4 percent of U.S. nursing home residents have no SDM or advance directives. Medical decision-making for this cohort poses an ethical challenge, particularly in the ED setting. Methods: A comprehensive review of the literature was conducted surrounding decision-making for incapacitated and unrepresented patients in the hospital setting. Articles were identified using MEDLINE (1946-October 2015) and Embase (1974-October 2015). The reference lists of relevant articles were hand searched. Articles describing decision-making processes that have been proposed, tested or applied in practice were chosen for full review. The aim of this review was to outline recognized medical decision-making processes for incapacitated and unrepresented patients, and to identify areas for future research. Results: The search yielded 20 articles addressing decision-making for incapacitated and unrepresented patients in the hospital setting. All of these articles focus on the intensive care unit and other hospital wards; no literature on the ED setting was found. Five types of formal consulting bodies exist to assist physicians in applying the best interest standard for this patient cohort: internal hospital ethics committees, external ethics committees, public guardians, court-appointed guardians, or judges. The majority of decisions for these patients, however, are made informally by a single physician or by a healthcare team, although it is well recognized that this approach lacks appropriate safeguards. There is no consensus surrounding the optimal approach to decision-making in these cases, and as such there is significant inconsistency in how medical decisions are made for these patients. Conclusion: There are several articles describing decision-making processes for incapacitated and unrepresented patients, none of which focus on the ED. These processes are not practical for use in the ED. Further inquiry is needed into the most ethical and respectful method of decision-making for this patient cohort in the ED.

scholarly journals From idealistic rookies to a regional leader: The history of health technology assessment in Poland

2009 ◽  
Vol 25 (S1) ◽  
pp. 156-162 ◽  
Author(s):  
Rafał Niżankowski ◽  
Norbert Wilk
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
The Public ◽  
History Of ◽  
Decision Making Processes ◽  
Public Payer

In 1989, Poland started to slowly release itself not only from the burden of a half-century of communist indoctrination and soviet exploitation, but also from the consequences of the Semashko model of healthcare organization: low doctors' salaries, primary care based on multispecialty groups, overdeveloped hospital infrastructure, and limited access to sophisticated interventions overcome by patients' unofficial payments.A few years after the 1998 workshop on health technology assessment (HTA) in Budapest, the first HTA reports were elaborated in the National Center for Quality Assessment in Health Care, which could mark the beginning of HTA in Poland. Several individuals and organizations have been involved in developing HTA, both from noncommercial and commercial standpoints.A goal to establish a national HTA agency appeared among the priorities of the Polish Ministry of Health in 2004 and was realized a year later. The Agency for HTA in Poland published guidelines on HTA and established a sound and transparent two-step (assessment-appraisal) process for preparing recommendations on public financing of both drugs and nondrug technologies. The recommendations of the Agency's Consultative Council were warmly welcomed by the public payer. However, the recent major restructuring of the Agency and new drug reimbursement decisions aroused doubts as to keeping transparency of the decision-making processes.

Ethical conflicts and the process of reflection in undergraduate nursing students in Brazil

2014 ◽  
Vol 22 (4) ◽  
pp. 428-439 ◽  
Author(s):  
Flávia Regina Souza Ramos ◽  
Laura Cavalcanti de Farias Brehmer ◽  
Mara Ambrosina Vargas ◽  
Ana Paula Trombetta ◽  
Luciana Ramos Silveira ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Nursing Students ◽  
Professional Training ◽  
Human Beings ◽  
Ethical Problems ◽  
Clinical Placements ◽  
Principal Axes ◽  
Ethical Conflicts ◽  
Decision Making Processes

Background: Nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. The initial act of perceiving a situation as causing an ethical dilemma is the result of both the students’ personal values, drawn from their culture and families, and of the professional knowledge and values that they have acquired through training and experience. Objectives: Nursing students’ experiences on clinical placements in primary care settings were investigated in order to identify situations that they perceived as involving ethical conflict and describe the elements they took into consideration during their decision-making processes in these situations. Methods: The research design was qualitative descriptive case study. Around 50 students from three different intakes to a nursing degree answered a questionnaire and discussed it in focus groups. Ethical considerations: The study was designed in accordance with the principles guiding research with human beings and was approved by the Human Research Ethics Committee. Results: Synthesised into two principal axes: (a) ethical conflicts in primary care, linked with the domains of working processes, professional nursing ethics and human and social rights and (b) students’ decision-making processes – realisation, reflection and intervention. Conclusion: The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems.

scholarly journals Primary Care and Emergency Department Decision Making

2001 ◽  
Vol 155 (11) ◽  
Author(s):  
Jennifer E. McNulty ◽  
Louis C. Hampers ◽  
Steven E. Krug
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Emergency Department

scholarly journals Assessing Patient Interest in Individualized Preventive Care Recommendations

2019 ◽  
Vol 4 (1) ◽  
pp. 238146831985080 ◽  
Author(s):  
Glen B. Taksler ◽  
Mary Beth Mercer ◽  
Angela Fagerlin ◽  
Michael B. Rothberg
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Focus Groups ◽  
Preventive Care ◽  
Preventive Services ◽  
Nationwide Survey ◽  
Sensitivity Analyses ◽  
Care Needs ◽  
Patient Decision Making ◽  
Evidence Based Care

Background. Few Americans obtain all 41 guideline-recommended preventive services for nonpregnant adults. We assessed patient interest in prioritizing their preventive care needs. Methods. We conducted a mixed-methods study, with 4 focus groups ( N = 28) at a single institution and a nationwide survey ( N = 2,103). Participants were middle-aged and older adults with preventive care needs. We obtained reactions to written materials describing the magnitude of benefit from major preventive services, including both absolute and relative benefits. Recommendations were individualized for patient risk factors (“individualized preventive care recommendations”). Focus groups assessed patient interest, how patients would want to discuss individualized recommendations with their providers, and potential for individualized recommendations to influence patient decision making. Survey content was based on focus groups and analyzed with logistic regression. Results. Patients expressed strong interest in individualized recommendations. Among survey respondents, an adjusted 88.2% (95% confidence interval [CI] = 86.7% to 89.7%) found individualized recommendations very easy to understand, 77.2% (95% CI = 75.3% to 79.1%) considered them very useful, and 64.9% (95% CI = 62.8% to 67.0%) highly trustworthy (each ≥6/7 on Likert scale). Three quarters of participants wanted to receive their own individualized recommendations in upcoming primary care visits (adjusted proportion = 77.5%, 95% CI = 75.6% to 79.4%). Both focus group and survey participants supported shared decision making and reported that individualized recommendations would improve motivation to obtain preventive care. Half of survey respondents reported that they would be much more likely to visit their doctor if they knew individualized recommendations would be discussed, compared with 4.2% who would not be more likely to visit their doctor. Survey respondents already prioritized preventive services, stating they were most likely to choose quick/easy preventive services and least likely to choose expensive preventive services (adjusted proportions, 63.8% and 8.5%, respectively). Results were consistent in sensitivity analyses. Conclusions. Individualized preventive care recommendations are likely to be well received in primary care and might motivate patients to improve adherence to evidence-based care.

Characteristics of patients presenting to an after-hours clinic: results of a MAGNET analysis

2017 ◽  
Vol 23 (3) ◽  
pp. 294 ◽  
Author(s):  
Lyle R. Turner ◽  
Christopher Pearce ◽  
Madeleine Borg ◽  
Adam McLeod ◽  
Marianne Shearer ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Emergency Department ◽  
Young Patients ◽  
Health Seeking ◽  
Care Services ◽  
Primary Care Services ◽  
Gp Services ◽  
After Hours ◽  
Delivery Strategies

After-hours access to general practice (GP) is critical to supporting accessibility and reducing emergency department demand. To understand who utilises after-hours GP services, this study examined the characteristics of presentations to an Eastern Melbourne after-hours clinic between 2005 and 2014. Descriptive analyses of patient and presentation characteristics, diagnoses, medications and pathology were conducted. Across the study period, 39.1% of presentations to the clinic (N=64,800) were by patients under 18 years of age. Females were found to attend more often than males, and nearly 79% of patients attended only once. The most common diagnoses were respiratory system diseases (13.4%), gastrointestinal system diseases (12.6%) and eye and ear problems (11.6%). Antibacterial medications accounted for over half (53.0%) of all prescriptions, with 34% of antibiotics prescribed to patients under 18 years of age. Seasonal variation in GP demand was also observed. Presenting patients differed from the wider GP patient population, with more young patients, and a higher proportion of prescriptions for antibacterial medications compared to other predominantly non-after-hours practices. Further research is required to understand the health-seeking, decision-making of patients who utilise after-hours GPs over predominantly non-after-hours primary care services, to inform service promotion and delivery strategies.

scholarly journals Management of burnout among the staff of primary care centres in Spain during the pandemic caused by the SARS-CoV-2

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Isaac Aranda-Reneo ◽  
Azucena Pedraz-Marcos ◽  
Montserrat Pulido-Fuentes
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Descriptive Analysis ◽  
Healthcare Management ◽  
Decision Makers ◽  
Medical Decision ◽  
Lower Probability ◽  
Specific Training ◽  
Decision Making Processes ◽  
Clinical Subtype

Abstract Background The provision of healthcare during the pandemic caused by the SARS-CoV-2 virus represented a challenge for the management of the resources in the primary care centres. We proposed assessing burnout among the staff of those centres and identifying factors that contributed to its appearance and those that limited it. Methods An observational study which, by means of anonymous questionnaires, collected information about: (i) demographic variables; (ii) the characteristics of each position; (iii) the measures implemented by the medical decision-makers in order to provide care during the pandemic; and (iv) the Burnout Clinical Subtype Questionnaire (BCSQ-36). We performed a descriptive analysis of the burnout mentioned by the staff, and, by means of a multivariate analysis, we identified the factors which influenced it. Using logit models, we analysed whether receiving specific training in COVID-19, feeling involved in decision-making processes, and/or working within different healthcare systems had effects on the development of burnout. Results We analysed the replies of 252 employees of primary care centres in Spain with an average age of 45 (SD = 15.7) and 22 (SD = 11.4) years of experience. 68% of the participants (n = 173) indicated burnout of the frenetic subtype. 79% (n = 200) of the employees had high scores in at least one burnout subtype, and 62% (n = 156) in at least two. Women older than 45 had a lower probability of suffering burnout. Receiving specific training (OR = 0.28; CI95%: 0.11–0.73) and feeling involved in decision-making (OR = 0.32; CI95%:0.15–0.70) each reduced the probability of developing burnout. Working in a different department increased the likelihood of developing burnout of at least one clinical subtype (OR = 2.85; CI95%: 1.38–5.86). Conclusions The staff in primary care centres have developed high levels of burnout. Participation in decision-making and receiving specific training are revealed as factors that protect against the development of burnout. The measures taken to contain the adverse effects of a heavy workload appear to be insufficient. Certain factors that were not observed, but which are related to decisions taken by the healthcare management, appear to have had an effect on the development of some burnout subtypes.

Frequent emergency department visitors are frequent primary care visitors and report unmet primary care needs

2016 ◽  
Vol 23 (3) ◽  
pp. 567-573 ◽  
Author(s):  
Amy Cunningham ◽  
Dawn Mautner ◽  
Bon Ku ◽  
Kevin Scott ◽  
Marianna LaNoue
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Needs

scholarly journals Decision-making Processes for a Patient Admitted to the Accident and Emergency Department Requiring Emergency Abdominal X-ray ― A Case Study

2016 ◽  
Vol 33 (1) ◽  
pp. 37
Author(s):  
Y. Yuliawati
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Descriptive Model ◽  
X Ray ◽  
Processing Theory ◽  
Accident And Emergency ◽  
Prescriptive Model ◽  
Decision Making Processes ◽  
Accident And Emergency Department

This study investigated the application of the various processes involved in decision-making for acase requiring radiologic emergency abdominal X-ray examination to the Accident and Emergency Department in a government-owned hospital in West Java, Indonesia. It is also aimed to evaluate the patient who was experiencing abdominal pain accompanied by bloating, vomiting, severe constipation and abdominal cramps.The decision-making models used for this case were the normative, prescriptive and descriptive judgments. A decision tree in the form of decision options that was employed in this case addressed the normative model of decision-making, while the algorithm and information processing theory focused on the prescriptive model. Lastly, the intuition that was used in this case concentrated on the descriptive model of decision-making. An emergency abdominal X-ray was indicated for the patient ― a prescriptive decision. Options from decision trees were also practiced. However, the patient was in pain; therefore, she was unable to understand the alternatives that were presented. Hence, this choice was suggested by the author because, by intuition, the expectation was that the patient suffered from acute abdominal crisis.

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