Department of Library and Information Science, Rutgers School of Communication and Information, New Brunswick, New Jersey, USA.
Department of Medicine, University of California San Francisco, San Francisco, California USA.
J Am Med Inform Assoc. 2019 Aug 1;26(8-9):813-824. doi: 10.1093/jamia/ocz053.
There are increasing efforts to capture psychosocial information in outpatient care in order to enhance health equity. To advance clinical decision support systems (CDSS), this study investigated which psychosocial information clinicians value, who values it, and when and how clinicians use this information for clinical decision-making in outpatient type 2 diabetes care.
This mixed methods study involved physician interviews (n = 17) and a survey of physicians, nurse practitioners (NPs), and diabetes educators (n = 198). We used the grounded theory approach to analyze interview data and descriptive statistics and tests of difference by clinician type for survey data.
Participants viewed financial strain, mental health status, and life stressors as most important. NPs and diabetes educators perceived psychosocial information to be more important, and used it significantly more often for 1 decision, than did physicians. While some clinicians always used psychosocial information, others did so when patients were not doing well. Physicians used psychosocial information to judge patient capabilities, understanding, and needs; this informed assessment of the risks and the feasibility of options and patient needs. These assessments influenced 4 key clinical decisions.
Triggers for psychosocially informed CDSS should include psychosocial screening results, new or newly diagnosed patients, and changes in patient status. CDSS should support cost-sensitive medication prescribing, and psychosocially based assessment of hypoglycemia risk. Electronic health records should capture rationales for care that do not conform to guidelines for panel management. NPs and diabetes educators are key stakeholders in psychosocially informed CDSS.
Findings highlight opportunities for psychosocially informed CDSS-a vital next step for improving health equity.
为了增强医疗公平性，越来越多的人努力在门诊护理中获取社会心理信息。为了推进临床决策支持系统（CDSS），本研究调查了临床医生重视哪些社会心理信息、谁重视这些信息，以及临床医生何时以及如何将这些信息用于门诊 2 型糖尿病护理的临床决策。
这项混合方法研究包括对医生的访谈（n=17）和对医生、护士从业者（NP）和糖尿病教育者的调查（n=198）。我们使用扎根理论方法分析访谈数据，使用描述性统计和按医生类型进行差异检验分析调查数据。
参与者认为经济压力、心理健康状况和生活压力源最为重要。NP 和糖尿病教育者认为社会心理信息更为重要，并且比医生更频繁地在 1 个决策中使用它。虽然一些临床医生总是使用社会心理信息，但另一些医生则在患者情况不佳时使用。医生使用社会心理信息来判断患者的能力、理解能力和需求；这影响了 4 个关键的临床决策。
触发社会心理信息 CDSS 的因素应包括社会心理筛查结果、新患者或新诊断的患者以及患者状况的变化。CDSS 应支持具有成本效益的药物处方，并基于社会心理评估低血糖风险。电子健康记录应捕获不符合小组管理指南的护理理由。NP 和糖尿病教育者是社会心理信息 CDSS 的关键利益相关者。
研究结果强调了社会心理信息 CDSS 的机会——这是改善医疗公平性的重要下一步。
