Complexity science: Complexity and clinical care

Wilson, Tim; Holt, Tim; Greenhalgh, Trisha

doi:10.1136/bmj.323.7314.685

Cited by 369 publications

(299 citation statements)

References 19 publications

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“…19 Therefore, their management is mandatory for the reduction of global CV Self-reported hypertension, dyslipidemia and hyperuricemia management u s e decisions. 4 u s e 4 Our study was consistent with other findu s e…”

Section: Discussionsupporting

confidence: 82%

“…One of the main issues seems to be the wrong perception of overall cardiovascular risk, which leads to inappropriate recommendations and treatment decisions. 4 Our study was consistent with other findings where risk assessment was suboptimal: 2,4 less than 35% of IMUs evaluated overall cardiovascular risk using scores recommended in the main guidelines.…”

Section: Discussionsupporting

confidence: 82%

“…In order to obtain the right diagnosis and prescribe proper treatment, a multidisciplinary approach is mandatory. 4 Current hypertension guidelines aim to improve the quality of patient care by providing specific recommendations for daily medical practice, 1 but despite considerable efforts in developing and implementing these evidence-based guidelines, adherence to recommendations is often suboptimal. 5 In clinical practice, many factors may influence the implementation of guidelines, and barriers to the adherence of recommendations can be related to the patient, who may have clinical features different to those of patients in randomized controlled trials, as well as to the physician and health-care system.…”

Section: Introductionmentioning

confidence: 99%

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Self-reported hypertension, dyslipidemia and hyperuricemia management by Italian Internal Medicine Units: a national survey of the FADOI Study Group in Cardiovascular Medicine

Mazza¹,

Lenti²,

D'Avino

et al. 2017

Ital J Med

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The aim of this study was to evaluate the management practices of internal medicine clinicians for patients with cardiovascular risk factors, with particular respect to treatment thresholds, medication choices and target goals. A sample of internists - representatives of Internal Medicine Units (IMUs) from all the regions in Italy - were identified by the cardiovascular medicine study group of the Italian Internal Medicine FADOI (Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti) Society and invited to fill out a questionnaire about hypertension, dyslipidemia and hyperuricemia. From the 101 questionnaires collected, it was found that despite large heterogeneity between IMUs in terms of patient management and adherence to guidelines, internists were experts in the management of patients with multiple cardiovascular risk factors and associated comorbidities. We hope that these data prompt the internal medicine community to consider the value of producing shared, real-world guidelines on the management of cardiovascular disease.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Self-reported hypertension, dyslipidemia and hyperuricemia management by Italian Internal Medicine Units: a national survey of the FADOI Study Group in Cardiovascular Medicine

Mazza¹,

Lenti²,

D'Avino

et al. 2017

Ital J Med

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“…31 In fact, by its very nature, primary care is more complex than specialty care. 32 To deal with this rise in the perceived complexity of expected care, the PCP must be able to respond with flexible decision making 33 and creativity. 30 Generally, combined strategies are required to deal with complex problems.…”

Section: Discussionmentioning

confidence: 99%

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Katerndahl

Parchman

Wood

2009

The Journal of the American Board of Family Medicine

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Background: The purpose of this study was to examine relationships of both perceived autonomy and perceived complexity of care with career satisfaction.Methods: This secondary analysis used 3 consecutive surveys of family physicians, internists, and pediatricians from the Community Tracking Survey. Two-way analysis of variance assessed interaction effects of perceived complexity of care and perceived autonomy on satisfaction. Logistic regression analysis identified physician characteristics, practice characteristics, practice improvement strategies, perceived complexity, and perceived autonomy that accounted for variance in career satisfaction among physicians.Results: Although 24% to 27% of physicians felt perceived complexity of care expected was greater than it should be, 83% to 86% felt free to make clinical decisions. Approximately 80% of physicians were satisfied with their careers. Differences in probability of career satisfaction were highly significant (P < .001) for both perceived complexity of care and perceived autonomy as well as their interaction. A multiphysician practice; the ability to obtain high quality ancillary services (such as physical therapy, home health care, and nutritional counseling); managed care revenue, lower levels of perceived complexity of expected care; and perceived autonomy were consistently associated with satisfaction.Conclusion: Higher perceived autonomy and lower perceived patient complexity as higher than desirable were associated with high career satisfaction among primary care physicians.

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“…Wilson & Holt, 2001;Curtis & Riva, 2010;Klijn & Snellen, 2010;O'Sullivan et al 2013, Boyd & Folke, 2012Lega & Calciolari , 2012) comprising 'agents' that are variably configured in different settings. These services and supporting infrastructures are impacted by 'extreme weather events' including heatwaves, floods and cold weather, (Oven et al 2012 ;DEFRA, 2012;Hames et al, 2012;IPCC, 2014;Plsek & Greenhalgh, 2001;Department of Health, 2011;Hames et al, 2012), in ways that depend upon their complex characteristics (Lanham et al, 2013;Joseph et al 2013), and vary due to local diversity in physical, social and institutional conditions (Dominelli, 2012;Carr-West et al 2011).…”

Section: Local Case Studies Of Complex Systems As 'Geographical Narramentioning

confidence: 99%

Adaptation to extreme weather events in complex health and social care systems: The example of older people’s services in England

Curtis

Oven

Wistow

et al. 2017

Environment and Planning C: Politics and Space

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Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. Our findings contribute to a growing international literature on how conceptual models from complexity theory may be relevant to inform planning in health and social care systems, helping to adapt and improve preparedness and resilience to extreme weather events. We focus on findings from two case studies in England and their relationship to national policy for adaptation. Complexity theory helped to frame strategies for planning for events that are emergent and unpredictable. We find from our case studies that, in spite of the uncertainty involved, some 'principles' derived from parts of the literature on complexity theory may provide a helpful framework for the development of more robust preparedness strategies in the health and social care sector. By viewing health and social care as a 'system of systems', adaptation planning recognises the interrelationships of built, institutional and social infrastructures. The idea of local systems, with variable, path dependent attributes, which are partially closed, but permeable to other parts of the wider network, leads to an actionable model of adaptation which emphasises the potential value of local self-organization, but also underlines the importance of coevolution across the wider system and the vital role for national initiatives and support for adaptation strategies. The value of sharing experience from local case studies across the national system, as well as among local partners, is very apparent in the experience reported here.https://mc04.manuscriptcentral.com/epc-pion Environment and Planning C: Politics and Space

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Complexity science: Complexity and clinical care

Cited by 369 publications

References 19 publications

Self-reported hypertension, dyslipidemia and hyperuricemia management by Italian Internal Medicine Units: a national survey of the FADOI Study Group in Cardiovascular Medicine

Self-reported hypertension, dyslipidemia and hyperuricemia management by Italian Internal Medicine Units: a national survey of the FADOI Study Group in Cardiovascular Medicine

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Adaptation to extreme weather events in complex health and social care systems: The example of older people’s services in England

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