GPs’ approaches to documenting stigmatising information: a qualitative study

Dossa, Almas; Welch, Leslie

doi:10.3399/bjgp15x685273

Cited by 8 publications

(11 citation statements)

References 18 publications

(21 reference statements)

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“…2 ): 15 based in the USA [ 33 – 47 ]; 11 Europe [ 48 – 58 ]; two Canada [ 59 , 60 ]; and one each in Saudi Arabia [ 61 ], Brazil [ 62 ], Hong Kong [ 63 ] and Israel [ 64 ]. The literature was methodologically diverse, including 11 qualitative studies [ 35 , 36 , 41 , 44 , 47 , 49 , 54 , 59 , 63 – 65 ], 17 cross-sectional surveys [ 33 , 34 , 37 , 39 , 42 , 43 , 45 , 46 , 50 – 52 , 55 – 58 , 60 , 62 ], one longitudinal survey [ 53 ] and four mixed methods studies [ 38 , 40 , 48 , 61 ]. Publication years ranged from 2001 to 2016.…”

Section: Resultsmentioning

confidence: 99%

“…Publication years ranged from 2001 to 2016. Of the 15 papers based on qualitative studies (including mixed methods studies with a qualitative component): one was deemed of low [ 61 ]; nine moderate [ 33 , 35 , 36 , 41 , 48 , 49 , 54 , 64 , 65 ]; and five high quality [ 44 , 47 , 59 , 63 ]. Of the 20 papers based on cross-sectional studies (or a cross-sectional component): 14 were moderate [ 37 , 38 , 40 , 42 , 43 , 45 , 46 , 48 , 55 – 58 , 60 , 61 ] and six high quality [ 34 , 39 , 50 – 52 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

“… Positive PCPs based in a group practice compared to single-handed practice. NR NR NR NR NR Dossa & Welch (2015) [ 35 ] QI (USA) NR Negative: Challenging to record sensitive information; Risk of stigmatising patients. NR NR NR NR NR NR Positive: Availability of robust EMR privacy laws.…”

Section: Resultsmentioning

confidence: 99%

“…Several papers highlighted the difficulties experienced when using EMRs to record certain types of patient data [ 35 , 49 , 57 ]. One study reported that PCPs found it challenging to record emerging diagnoses and/or vague symptoms, particularly when a diagnosis was potentially sensitive or stigmatising [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

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Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework

O’Donnell

Kaner

Shaw

et al. 2018

BMC Med Inform Decis Mak

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BackgroundRecent decades have seen rapid growth in the implementation of Electronic Medical Records (EMRs) in healthcare settings in both developed regions as well as low and middle income countries. Yet despite substantial investment, the implementation of EMRs in some primary care systems has lagged behind other settings, with piecemeal adoption of EMR functionality by primary care physicians (PCPs) themselves. We aimed to review and synthesise international literature on the attitudes of PCPs to EMR adoption using the Clinical Adoption (CA) Framework.MethodsMEDLINE, PsycINFO, and EMBASE were searched from 1st January 1996 to 1st August 2017 for studies investigating PCP attitudes towards EMR adoption. Papers were screened by two independent reviewers, and eligible studies selected for further assessment. Findings were categorised against the CA Framework and the quality of studies assessed against one of three appropriate tools.ResultsOut of 2263 potential articles, 33 were included, based in North and South America, Europe, Middle East and Hong Kong. Concerns about the accessibility, reliability and EMR utility exerted an adverse influence on PCPs’ attitudes to adoption. However many were positive about their potential to improve clinical productivity, patient safety and care quality. Younger, computer-literate PCPs, based in large/multi-group practices, were more likely to be positively inclined to EMR use than older physicians, less-skilled in technology use, based in solo practices. Adequate training, policies and procedures favourably impacted on PCPs’ views on EMR implementation. Financial factors were common system level influencers shaping EMR adoption, from start-up costs to the resources required by ongoing use.ConclusionsBy using the CA Framework to synthesise the evidence, we identified a linked series of factors influencing PCPs attitudes to EMR adoption. Findings underline the need to involve end-users in future implementation programmes from the outset, to avoid the development of an EMR which is neither feasible nor acceptable for use in practice.Trial registrationPROSPERO CRD42016038790.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework

O’Donnell

Kaner

Shaw

et al. 2018

BMC Med Inform Decis Mak

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“…However, there is increasing recognition of unintended consequences of EPRs and their impact on individual and organisational behaviour 18 – 20. Specifically, there are ongoing professional concerns about documenting stigmatising information, including DVA 21. With DVA, confidentiality is essential given the risk of abuse escalation when a perpetrator discovers disclosure.…”

Section: Introductionmentioning

confidence: 99%

Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children

Drinkwater¹,

Stanley

Szilassy

et al. 2017

Br J Gen Pract

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BackgroundDomestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.AimTo explore how and why general practice clinicians document DVA in families with children.Design and settingA qualitative interview study using vignettes with GPs and practice nurses (PNs) in England.MethodSemi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes.ResultsMost clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians.ConclusionManaging DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access.

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Expectations for Artificial Intelligence (AI) in Psychiatry

Monteith

Glenn²,

Geddes

et al. 2022

Curr Psychiatry Rep

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Purpose of Review Artificial intelligence (AI) is often presented as a transformative technology for clinical medicine even though the current technology maturity of AI is low. The purpose of this narrative review is to describe the complex reasons for the low technology maturity and set realistic expectations for the safe, routine use of AI in clinical medicine. Recent Findings For AI to be productive in clinical medicine, many diverse factors that contribute to the low maturity level need to be addressed. These include technical problems such as data quality, dataset shift, black-box opacity, validation and regulatory challenges, and human factors such as a lack of education in AI, workflow changes, automation bias, and deskilling. There will also be new and unanticipated safety risks with the introduction of AI. Summary The solutions to these issues are complex and will take time to discover, develop, validate, and implement. However, addressing the many problems in a methodical manner will expedite the safe and beneficial use of AI to augment medical decision making in psychiatry.

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GPs’ approaches to documenting stigmatising information: a qualitative study

Cited by 8 publications

References 18 publications

Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework

Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework

Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children

Expectations for Artificial Intelligence (AI) in Psychiatry

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