Differences in Clinical Decision Making Between Internists and Cardiologists

Glassman, Peter; Kravitz, Richard L.; Petersen, Laura; Rolph, John E.

doi:10.1001/archinte.1997.00440260044008

Cited by 30 publications

(10 citation statements)

References 16 publications

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“…Vignettes or written case simulations have been used by educators, demographers and health service researchers to measure processes in a wide range of practice (Sriram et al. 1990; Glassman et al. 1997; Peabody et al.…”

Section: Methodsmentioning

confidence: 99%

Do poor people use poor quality providers? Evidence from the treatment of presumptive malaria in Nigeria

Onwujekwe

Hanson

Uzochukwu

2011

Tropical Med Int Health

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Everybody used poor quality malaria treatment services but the poor people used providers with poor quality malaria treatment services more than others. The major driver of disparities in use of different providers by different SES was the greater number of visits of the higher SES groups, rather than the higher quality of the providers they used. Interventions should be developed to improve quality of treatment seeking behaviour and provision practices.

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Section: Methodsmentioning

confidence: 99%

Do poor people use poor quality providers? Evidence from the treatment of presumptive malaria in Nigeria

Onwujekwe

Hanson

Uzochukwu

2011

Tropical Med Int Health

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“…Vignettes are written cases that simulate actual clinical practice. Educators, demographers, and health service researchers have used these vignettes to measure processes in a wide range of settings [ 13 - 15 ].…”

Section: Introductionmentioning

confidence: 99%

Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

2006

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Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV). Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1) If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU)?; 2) Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3) If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate), who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79%) of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74%) of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36%) of practitioners would re-dose the 5-HT3-antagonist for PONV treatment. Conclusion 5-HT3-antagonists are the most common choice for treatment of established PONV for outpatients when no prophylaxis is used, and also following prophylactic regimens that include a 5HT3 antagonist, regardless of the number of prophylactic antiemetics given. Whereas 3% – 7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% of practitioners would re-dose the 5-HT3-antagonist for PONV treatment.

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“…Because most health care expenditures are the results of doctors' decisions, whether doctors are cost-conscious is an important matter. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics [ 1 , 2 ], training [ 3 - 6 ], work context [ 7 , 8 ], financial incentives [ 9 , 10 ] and information about costs [ 11 - 13 ]. Medical decisions are also influenced by subjective considerations, including risk aversion [ 14 , 15 ], tolerance for uncertainty [ 16 ], and concerns about cost and income [ 17 ].…”

Section: Introductionmentioning

confidence: 99%