Potilaiden ja läheisten osallisuuden edistäminen akuuttipsykiatrian osastoilla : ammattilaisten näkökulma

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The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

Tietokoneavusteisen päätöksentukipalvelun perusedellytysten toteutuminen ‐ kyselytutkimus Päätöksentuki ‐hankkeen pilottialueilla

Tutkimuksen tarkoituksena oli arvioida, miten tietokoneavusteisen päätöksentuen perusedellytykset toteutuvat Päätöksentuki ‐hankkeen pilottialueilla. Sähköpostitse tehtyyn kyselyyn vastasi 806/2252 terveydenhuollon ammattilaista. Vastausten mukaan lähes kaikki potilastyötä tekevät ammattilaiset käyttivät sähköistä potilaskertomusta,mutta käyttötavoissa oli huomattavia ammattiryhmäkohtaisia eroja. Ammattiryhmien välillä oli eroja potilastiedon rakenteisessa kirjaamisessa diagnoosiluokitusten ja sähköisten lomakkeiden käytön osalta. Lähes puoletvastaajista arvioi oman tietoteknisen osaamisensa hyväksi tai erittäin hyväksi. Tulosten perusteella tietokoneavusteisen päätöksentukipalvelun perusedellytykset vaihtelevat vastaanottotyössä ja osastotyössä sekä ammattiryhmittäin. Tämä tulee ottaa huomioon suunniteltaessa päätöksentukipalvelun käyttöönottoja

Työn piirteet ja hoitusuositusasenteet terveydenhuollon ammattilaisilla

Tutkimuksessa kuvattiin ja vertailtiin lääkäreiden, sairaanhoitajien ja terveydenhoitajien (n = 687) hoitosuositusasenteita ja työn piirteitä. Tavoitteena oli tutkia, ovatko työn piirteet välittäviä (mediaattoreita) tai muovaavia (moderaattoreita) tekijöitä ammatin ja hoitosuositusasenteiden välisessä suhteessa. Aineiston keruumenetelmänä oli sähköpostikysely. Hoitosuositusasenteita tutkittiin Elovainion yhdessä työtovereidensa kanssa kehittämällä hoitosuositusasennemittarilla ja työn psyykkistä kuormittavuutta Karasekin työn vaatimusten ja hallinnan mallilla. Lisäksi tutkittiin työntekijöiden kokemuksia sosiaalisen tuen puutteesta ja tietoteknisistä ongelmista. Työn kuormittavuudella sekä kokemuksilla sosiaalisen tuen puutteesta ja tietoteknisistä ongelmista oli yleisesti vaikutusta ammatin ja asenteiden väliseen suhteeseen. Joitakin ammattiryhmäkohtaisia eroja esiintyi. Huomiota tulisi kiinnittää työolojen kehittämiseen uusien toimintakäytäntöjen omaksumista edistäviksi

Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

Background Finnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour. Methods A cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions. Results The results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context- and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals. Conclusions The results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.BioMed Central Open acces

Implementing clinical decision support for primary care professionals – the process

We describe the process of putting into practice a computer-based clinical decision support (eCDS) service integrated in the electronic patient record, and the actual use of eCDS after one year in a primary care organization with 48 health care professionals. Multiple methods were used to support the implementation. The actual use was measured by means of a questionnaire and statistical data. The implementation process consisted of threesuccessive training rounds and lasted for 18 months. After 12 months the reported actual use of the eCDS functions was diverse. The study indicates that successful implementation of eCDS requires time and repeated supportive input. Primary care professionals need time and training for adapting eCDS in their daily routine. In addition, the eCDS content should be tailored to fulfil different professionals’ information needs in primary care practice

The perceptions of different professionals on school absenteeism and the role of school health care : A focus group study conducted in Finland

Purpose of the study School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different professionals working in schools recognize for absenteeism and which factors either promote or inhibit the inclusion of school health care in absenteeism reduction. Materials and methods Data for this qualitative study was gathered from ten focus groups conducted in two municipalities in southern Finland. The groups included (vice) principals, special education/resource/subject teachers, guidance counselors, school social workers, school psychologists, school nurses, school doctors, and social workers working in child protective services. Data analysis was predominantly inductive but the categorization of our results was based on existing literature. Results Study participants identified student-, family-, and school-related reasons for absenteeism but societal reasons went unmentioned. A number of reasons promoting the inclusion of school health care in absenteeism reduction arose, such as expertise in health-related issues and the confidentiality associated with health care. Inclusion of school health care was hindered by differences in work culture and differing perceptions regarding the aims of school health care. Conclusion Professionals working in schools were knowledgeable about the different causes of school absenteeism. Clarifying both the aims of school health care and the work culture of different professionals could facilitate the inclusion of school health care in absenteeism reduction.Peer reviewe

Clinical decision support must be useful, functional is not enough: a qualitative study of computer-based clinical decision support in primary care

ABSTRACT: BACKGROUND: Health information technology, particularly electronic decision support systems, can reduce the existing gap between evidence-based knowledge and health care practice but professionals have to accept and use this information. Evidence is scant on which features influence the use of computer-based clinical decision support (eCDS) in primary care and how different professional groups experience it. Our aim was to describe specific reasons for using or not using eCDS among primary care professionals. METHODS: The setting was a Finnish primary health care organization with 48 professionals receiving patient-specific guidance at the point of care. Multiple data (focus groups, questionnaire and spontaneous feedback) were analyzed using deductive content analysis and descriptive statistics. RESULTS: The content of the guidance is a significant feature of the primary care professional's intention to use eCDS. The decisive reason for using or not using the eCDS is its perceived usefulness. Functional characteristics such as speed and ease of use are important but alone these are not enough. Specific information technology, professional, patient and environment features can help or hinder the use. CONCLUSIONS: Primary care professionals have to perceive eCDS guidance useful for their work before they use it.Peer reviewe

Patient-specific computer-based decision support in primary healthcare-a randomized trial

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