How Knowledge Is Constructed and Exchanged in Virtual Communities of Physicians: Qualitative Study of Mindlines Online

Wieringa, Sietse; Engebretsen, Eivind; Heggen, Kristin; Greenhalgh, Trisha

doi:10.2196/jmir.8325

Cited by 25 publications

(24 citation statements)

References 57 publications

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“…(20) Thus, GPs' decision-making, informed in part by available evidence and guidance, is refined through reference to the outcomes of previous decisions, whether their own or their colleagues'. Information is negotiated, shared, and tested in a community of practice on an ongoing basis, with iterative development of in-practice knowledge (20,21). Importantly, mindlines develop and strengthen continually in response to newly emerging evidence as well as the need to act (22).…”

Section: Introductionmentioning

confidence: 99%

GPs’ mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice

et al. 2020

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Background: Optimal management of hypertension in older patients with multimorbidity is a cornerstone of primary care practice. Despite emphasis on personalised approaches to treatment in older patients, there is little guidance on how to achieve medication reduction when GPs are concerned that possible risks outweigh potential benefits of treatment. Mindlines – tacit, internalised guidelines developed over time from multiple sources – may be of particular importance in such situations. Aim: To explore GPs’ decision-making on deprescribing antihypertensives in multimorbid patients over 80 years old, drawing on the concept of mindlines. Design: Qualitative interview study. Setting: English general practice. Methods: Thematic analysis of face-to-face interviews with a sample of 15 GPs from 7 practices in the East of England, using a chart-stimulated recall approach to explore approaches to treatment for older multimorbid patients with hypertension. Results: GPs are typically confident making decisions to deprescribe antihypertensive medication in older multimorbid patients when prompted by a trigger, such as a fall or adverse drug event. GPs are less confident to attempt deprescribing in response to generalised concerns about polypharmacy, and work hard to make sense of multiple sources (including available evidence, shared experiential knowledge, and non-clinical factors) to guide decision-making. Conclusion: In the absence of a clear evidence base on when and how to attempt medication reduction in response to concerns about polypharmacy, GPs develop ‘mindlines’ over time through practice-based experience. These tacit approaches to making complex decisions are critical to developing confidence to attempt deprescribing, and may be strengthened through reflective practice.

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Section: Introductionmentioning

confidence: 99%

GPs’ mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice

et al. 2020

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“…A smaller number were faithful to the original Gabbay and le May’s conceptualisation but add little by way of new understanding. More recently, Wieringa and colleagues49 investigated mindlines development in online clinical communities concluding that they offered collective, dynamic settings and suggest implicitly that they may be areas for mindline amendment. While online communities may appeal to some practitioners, this will not be so for all.…”

Section: Discussionmentioning

confidence: 99%

Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK

Cowdell

2019

BMJ Open

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ObjectiveTo explore how atopic eczema specific mindlines are developed by primary care practitioners.DesignEthnographic study.SettingOne large, urban general practice in central England.ParticipantsIn observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16).ResultsObservation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static.ConclusionsThe outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.

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“…Our research suggests that evidence-based medicine has been incorporated into the work of the CTU teams studied here, just not in the ways envisioned by health administrators and policy makers who frequently equate low CPG uptake and a lack of standardization with not practicing evidence-based medicine. Instead of drawing on CPGs, CTU teams invoke and read a variety of evidence sources, blending them together to arrive at shared understandings of patient care [19,26,27]. As clinicians increasingly rely on their smartphones to access information, health administrators and policy makers will decreasingly be able to control the type and quality of information they access.…”

Section: Discussionmentioning

confidence: 99%

“…More recent studies assessed the impact of smartphones and information retrieval technologies on primary care clinicians [16,17] and internal medicine residents [18], arguing that these technologies increase the degree and variety of evidence accessed by clinicians. Others have assessed how virtual networks of clinicians inform the development of mindlines [19]. None of these studies observed how clinicians used scientific evidence in their daily work.…”

Section: Introductionmentioning

confidence: 99%

Exploring How Evidence is Used in Care Through an Organizational Ethnography of Two Teaching Hospitals

Lander¹,

Balka²

2019

J Med Internet Res

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Background Numerous published articles show that clinicians do not follow clinical practice guidelines (CPGs). However, a few studies explore what clinicians consider evidence and how they use different forms of evidence in their care decisions. Many of these existing studies occurred before the advent of smartphones and advanced Web-based information retrieval technologies. It is important to understand how these new technologies influence the ways clinicians use evidence in their clinical practice. Mindlines are a concept that explores how clinicians draw on different sources of information (including context, experience, medical training, and evidence) to develop collectively reinforced, internalized tacit guidelines. Objective The aim of this paper was to explore how evidence is integrated into mindline development and the everyday use of mindlines and evidence in care. Methods We draw on ethnographic data collected by shadowing internal medicine teams at 2 teaching hospitals. Fieldnotes were tagged by evidence category, teaching and care, and role of the person referencing evidence. Counts of these tags were integrated with fieldnote vignettes and memos. The findings were verified with an advisory council and through member checks. Results CPGs represent just one of several sources of evidence used when making care decisions. Some forms of evidence were predominately invoked from mindlines, whereas other forms were read to supplement mindlines. The majority of scientific evidence was accessed on the Web, often through smartphones. How evidence was used varied by role. As team members gained experience, they increasingly incorporated evidence into their mindlines. Evidence was often blended together to arrive at shared understandings and approaches to patient care that included ways to filter evidence. Conclusions This paper outlines one way through which the ethos of evidence-based medicine has been incorporated into the daily work of care. Here, multiple Web-based forms of evidence were mixed with other information. This is different from the way that is often articulated by health administrators and policy makers whereby clinical practice guideline adherence is equated with practicing evidence-based medicine.

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How Knowledge Is Constructed and Exchanged in Virtual Communities of Physicians: Qualitative Study of Mindlines Online

Cited by 25 publications

References 57 publications

GPs’ mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice

GPs’ mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice

Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK

Exploring How Evidence is Used in Care Through an Organizational Ethnography of Two Teaching Hospitals

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