Cost Of Medical Decision Making From Non-Medical Managers: Literature Review

Introduction to nonclinical influences

Discuss about the Cost Of Medical Decision Making From Non-Medical Managers.

Procedures of clinical making decision is the essential in our day to day clinical exercises. The processes involving interactions of applications of biomedical and clinical problems solving, knowledge, probability weighing and several outcomes, and to balance risk-benefits. Crucial tasks are balancing personal experiences and common knowledge (Hajjaj, et al., 2015). Evidences based medicine protocol provides the path to physicians allowing them in making comprehensive therapeutic decision with elements of self-confidence instead of based on individual experiences. Making clinical decisions is processes and to make an informed judgments about the treatments essential for the patients (Hardy & Smith, 2009). Making decision processes are complex involving numerous significant steps in which patients’ involvement is essential (Hajjaj, et al., 2015):

Cost of clinical decision-making is defined in different ways depending on different referenced article. According to (Hajjaj, et al., 2015), it is defined as the utmost essential parts of a clinical practices, it permits the medical practitioners in making scientific, logical and valid decisions in regard of the care implementation and planning of the intervention. In any clinical situation, where patients presents their medical complications, the initial sequence of actions by the healthcare specialized requires logical clinical making decision. Consequently, the significance of the clinical making decisions are dominant when it arises to the healthcare industries (Stevenson, et al., 2012). Even though, it requires to be considered that this kind of particular actions are  complicated and any single mistake while making critical clinical decision mat cost the patients even their lifes (Stevenson, et al., 2012).

Henceforth, decision making in clinics may be reflected as the foundations based on which the treatments recovery and delivery of patients will be carried on. Conversely, typical misconceptions when clinical making decisions are discussed, are that it depend on the self-control of the healthcare professional, like the doctors, nurses or so on (Park & Yabuuchi, 2016). Nevertheless, the clinical decision-making are parts of health care that are most influenced sectors, in both by external and internal factors. The literature review focusses on the cost in decision making.

Even though clinical decisions making, most of them are based on formally or traditionally clinical criteria for making clinical decision, they are furthermore affected by a broad range of nonclinical aspects, such as, the socio-economic conditions of the patient. Some effects cannot be distinguished whether it fall in nonclinical or clinical factors, for instance, adherence of the patient. Adherence of the patient may fall in clinical factor, but then, if associated with, such as, regular absenteeism from the follow-up appointment, it is then taken as nonclinical influence. Patient age could be considered to be a clinical rather than nonclinical influence because it is associated with physical ability and other co-morbidities. Likewise, the age of the patients may be a nonclinical effect because of the associated nonclinical features, such as transportations problem in the ageing, making follow-up appointment much problematic (Hajjaj, et al., 2015).

Literature review

Consequently, sometimes it is impossible to classify every effects on clinical decisions into either nonclinical or clinical, since there exists an overlap in the two. Artificial descriptors of nonclinical influences on clinical making decision can be used so as to focus thoughtful on a broad aspects of clinical medicines. The following are some nonclinical effects on clinical making decisions:

• Factors related to patient.

These factors involves: concerns and worries of the patient, attitude and behavior of the patient, wishes and preferences of the patient, gender and age of the patient, and other individual characteristics. Race of the patient, patient’s socioeconomic status and also adherence to treatment or inappropriate behavior of the patient that may influence adherence such as chaotic life style.

• Physician-related factors

These may involve; physician’s professional interaction like interaction of staffs and colleagues within clinics, time constraint and work overload of physician in the clinic, personal characteristics of physician like race, faith, culture, age and gender.

• Practice-related factors

These type of practices such as public or private, practice’s size, practice organizations, geographical locations, and accessibility of health resources

The main purposes of the literature reviews are to help in understanding what other researchers and writers have documented about the importance of the economic and social cost in medical decision making from non-medical managers. Int this part few factors mentioned above are examined.

The socioeconomic status of the patient

The socio-economic status of the patient affects way the decisions are made in the managements. In many countries, being alert of the socioeconomic status of the patients, let say the patient have a low socio-economic may influence primary care physician to change his/her managements plans to outfit the patient with financial difficulties (Bernheim, et al., 2008). The influences of socio-economic status can lead to non-standard treatments or the patient may receive less than ideal.

The ability of the patient to pay and the cost of care influences the therapeutic plan of the physician. Patients having a socio-economic status having the ability to carter the cost of health facilities are possibly able to have more medical tests as compared to patient with a low socio-economic status (Scott, et al., 2016). Physician may change his/her prescription strategies, shifts to an inexpensive drugs within therapeutic classes or they tend to shift to an alternative drug which is insured (Huttin & Andral, 2010) (Hajjaj, et al., 2015). Even amid patients who are insured there may exists some with insurances plan which may give a coverage which is limited (Huttin & Andral, 2010) (Shi, 2013). This socio-economic status disparities may decrease the qualities of patients care and result in unwanted consequences.

Factors related to the patient

The age of the patients can affect cost of clinical management decisions. Physician is probably in categorizing the grievances of aged persons as ordinary or age related instead of the signs of diseases (Haug & Ory, 2007). A cross-sectional study (Little, et al., 2005) of two universal practices found that aged persons are not as much of younger persons to be offered health promotions advices.

The gender of the patient plays an deceptively inappropriate roles in clinical making decisions. For instance, women receives more physical examination test, drug prescription, blood pressure check, laboratory test and return appointments as compared to men. Women similarly have more physician’s visits per a given period of time and more services per visit (Verbruggei, et al., 2011). Physician typically perceives that the complaints of women are more possible to be affected by emotional factors and furthermore, women makes extreme demands on the time of the physician (Hajjaj, et al., 2015).

The views of the adherence to medications to the patient by the physician is other essential factors which might influence management making decisions (Piette, et al., 2014). Physician might be more unlikely to treat patient who he or she suspects would abandon to treatments (Bogart, et al., 2016).

Occasionally physicians may encounter patients who are rude, aggressive, demanding, violent or patient seeking secondary gain. These kind of patients visits their doctors or nurses more often than normal, receives extra prescription, having extra tests prepared, and they are  referred to specialists more frequently (D & Tabenkin, 2011).

Management policies

There are some weight put on insurance companies, hospitals, physicians and employers in considering cost when do provide care to patients. Here, there exist risks that the pressure might results to decrease in the general value of healthcare. For instance, resources constraint in ICU (Intensive Care Units) may lead in early release of patient and these may be related to an improved mortality rates (Murray, 2010). The decision making of the manager may differ from one person to another or from healthcare to another to another due to variances in treatment policies and healthcare systems (Hajjaj, et al., 2015).

Physician personal characteristics

The physician’s decision making processes may be affected by his or her own personal characteristic. For instance, the characteristics of the doctors or nurses determines, as a minimum in parts, their approaches to patients’ managements. Physician can be categorized (Eisenberg, 2000) as either oriented towards health maintenances or interventionists. Health maintenance physician is patient-oriented, while Interventionist physicians are disease-oriented. In general, the health maintenance-oriented physicians are prepared in observing the situations, but, the interventionist is inclined toward immediate actions (Hajjaj, et al., 2015). The ethnicity, age and gender of the physician plays a role in decision-making

Research Objective:

The age of the patient

Statistical analysis based on different hospitals data base to find out the economic and social cost in medical decision making from non-medical managers mainly those relate to patients’ characteristics.

What are some nonmedical Characteristics of the patient that contributes to collective medical decision making?

Method

Here, the observations was taken in French cancer centers in medical decision making at which nonstandard gears involves some improbability were debated on May to July 2014 (Thémis, et al., 2016). Verbal statements of the physicians and predefined background parameters was collected with a nonparticipants observational approaches. Nonnumeric information collected in the forms of open notes was then coded for quantitative analysis. Multivariate and univariate statistical analyses was performed.

Hypothesis:

Contribution to the knowledge gap in healthcare management to highlight the loop holes of administration by non-medical managers. – Analysis of data through various aspects to improve the administration role in healthcare management by discussing decision making techniques.

The final samples of records of the patient included and discussed where n=290, nonmedical characteristics was stated as n=95, that is 32.8 percent of the eccentrics. There were n=66 (that is 22.8 percent) of these cases characteristics resembled to demographics. Psychological information in 11.7 percent (that is n = 34), and relational information in 6.2 percent (that is n = 18). The patient’s age and his/her congeniality was found to be more frequently stated characteristic. In 17.9 percent of these eccentrics debated, the concluding decision was delayed: the outcomes were completely related with the nonmedical characteristics of the patient and with indecision about the outcomes of the therapeutic options available.

Amongst completed case-records planned for debate at the medical decision making process meetings, two hundred and ninety patients cases was involved in the analysis. The cases was excluded were two hundred and forty two cases that did not meet the included criteria either due no argument was needed about the medical managements or is due to removal of the agenda of the medical decision making process. The issues to be discussed at future session can be included since main medical data was absent or a better method to collect the data was not used. The mean age of the patients used was 61.1 having a standard deviation of 14.3. The gender of the patient used were: male were 118 representing 41.8 percent while female were 164 representing 58.2 percent.

Gantt charts arranges different activities or events in synchronism and associates respectively tasks with its precedency and time. It displays activities or events as timed bars and graphically visualize the sequences of those activities/events (Bryan, 2016).

TIME Activities	Week 1	Week 2	Week 3	Week 4	Week 5
Research
Design
Layout
Develop
Finish

The gender of the patient

Conclusion

The deficiency of sympathetic of nonclinical affects by the physicians while assembling management decisions might possibly results into suboptimal individuals patients care. Nonetheless physician can try acting in a evidence based, rational and professional manners, they furthermore, must take into consideration in the unique circumstance of individuals patient in his or her clinical practices and respects the value of the patients and beliefs. Treatments policy promotes managements of all patients similarly deprived of differentiating between them since of religion or race, sexual orientation, age and gender for ensuring provision of the highest qualifies healthcare to any patient.

From the literature review, it indicate that one of the highest challenge clinical medicine encountered in the current centuries are developments of strategic that can integrate and acknowledge significant nonclinical effects with evidence-based medicines deprived of affecting the standards of complete healthcare’s (Hajjaj, et al., 2015). Physician cannot be able to practice true evidence-based medicine unless nonclinical effects on decision making are understood, documented and cooperatively taken into account during the process of cost of clinical decision making..

References

Bernheim, S., Ross, J., Krumholz, H. & E.H., B., 2008. Influence of patients’ socioeconomic status on clinical management decisions: a qualitative study.. Ann Fam Med, 6(1), pp. 53-59.

Bogart, L., Kelly, J., Catz, S. & Sosman, J., 2016. Impact of medical and non-medical factors on physician decision making for HIV/AIDS antiretroviral treatment. J Acqui Immune Defic Syndr, Issue 23, pp. 396-397.

Bryan, J. W., 2016. A PROJECT PLANNING GUIDE FOR HEALTHCARE FACILITY, s.l.: Walrath.

D, S. & Tabenkin, H., 2011. The ‘difficult patient’ as perceived by family physicians.. Fam Pract, Issue 18, p. 497.

Eisenberg, J., 2000. Sociologic influences on decision making by clinicians. Ann Intern Med, Issue 90, p. 960.

Hajjaj, F., M.S., S., Basra1, M. & Finlay, A., 2015. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice. Journal of the Royal Society of Medicine, 103(5), pp. 178-187.

Hardy, D. & Smith, B., 2009. Decision making in clinical practice. Br J Anaesth, Issue 9, pp. 28-30.

Haug, M. & Ory, M., 2007. Issues in elderly patient-provider interactions. Res Aging, Issue 9, pp. 11-15.

Huttin, C. & Andral, J., 2010. How the reimbursement system may influence physicians’ decisions. Results from focus groups interview in France. Health Policy, Issue 54, pp. 67-80.

Little, P., Slocock, L., Griffin, S. & Phillinger, J., 2005. Who is targeted for lifestyle advice? A cross sectional study in two general practices.. Br J Gen Pract , Issue 49, pp. 809-810.

Murray, S., 2010. Relation between private health insurance and high rates of caesarean section. qualitative and quantitative study, pp. 1503-1504.

Park, I. & Yabuuchi, A., 2016. More options, more considerations: how new treatment options influence clinical decision making.. Journal of thoracic disease, 8(10), p. p.E1408.

Piette, J. P., Wagnes, T., Potter, M. & Schillinger, D., 2014. Health insurance status, cost-related medication under use and outcomes among diabetes patients in three systems of care. Med Care, Volume 9, p. 103.

Scott, A., Shiell, A. & King, M., 2016. Is general practitioner decision making associated with patient socio-economic status?. Soc Sci Med, pp. 35-46.

Shi, L., 2013. Types of health insurance and the quality of primary care experience.. Am J Public Health, p. 1848–1855.

Stevenson, L. et al., 2012. Decision making in advanced heart failure. Circulation, 125(15), pp. 1928-1937.

Stough, C. et al., 2016. ignette methodologies for studying clinicians’ decision-making: validity, utility, and application in ICD-11 field studies.. International Journal of Clinical and Health Psychology, 15(2), pp. 162-180.

Thémis, A., Anne-Déborah, B., Sylvain, G. & Aurran, T., 2016. Patients’ Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings. Research Article, p. 15.

Verbruggei, L., Steiner, R. & ., 2011. Physician treatment of men and women patients: sex bias or appropriate care?. med care, pp. 610-620.