Clinician Attitudes Research Articles

Impact of Brief Patient Exposure on Pre-Clinical U.S. Medical Student Bias Towards Mental Health.

Negative bias towards patients with mental illness contributes to worsened healthcare outcomes. However, few data exist on interventions to decrease bias. In this study, the authors examined the impact of brief patient exposure on first-year medical student perceptions of psychiatry. In 2023, two townhalls were introduced to the psychiatry course for first-year medical students at Indiana University School of Medicine. Participants were surveyed before and after the course using the Mental Illness: Clinician's Attitudes version 2 (MICA-2), with higher scores indicating more negative bias. Pre- and post-course scores were compared with paired t-tests. Level of pre-course bias in years with townhalls (2023 and 2024) was compared to the year without townhalls (2022) with an unpaired t-test. Impact of townhalls was assessed by comparing 2022 data to 2023 and 2024 with repeated measures analysis of variance (ANOVA). Response rates ranged from 22.5 to 32.0%. The combined 2023 and 2024 pre- and post-course MICA-2 means were 36.5 (SE 0.6) and 34.8 (SE 0.6), respectively. The pre-course means were not significantly different from 2022's, indicating a consistent level of baseline bias (t(236) = 0.11, p = 0.92). Repeated measures ANOVA indicated change attributed to the course was significantly less in years with townhalls (2023 and 2024) compared to the year without (2022; F = 4.04, p = 0.045). Contrary to the hypothesis, added patient volunteer exposure resulted in less reduction in bias compared to the year without such exposure. These findings suggest increased complexity in reducing bias; timing and context of patient exposures may be important determinants of effect on bias.

Patient and clinician satisfaction with home parenteral nutrition intestinal failure telemedicine consultations: A survey of clinicians and patients.

Despite the widespread use of telemedicine to assess patients with intestinal failure (IF) receiving home parenteral nutrition (HPN), satisfaction with remote consultation methods has not been comprehensively assessed. Here, we assessed patient and clinician attitudes to telephone and video IF consultations. Telemedicine questionnaires were designed and distributed in paper form to patients with IF receiving HPN under the care of a UK national IF reference center and electronically to IF clinicians in Europe, North America, Australia, and New Zealand. Seventy-eight patients (53 women and 25 men) and 110 clinicians agreed to complete the questionnaires. Sixty seven percent of patients who had telephone consultations and 50% of patients who had video consultations were satisfied with their consultations. Forty nine percent and 83% of patients who had telephone and video consultations, respectively, felt they were of the same standard as their face-to-face consultations. Despite 60% of clinicians feeling telemedicine training would be useful, 55% of clinicians stated they mostly or always met all of the needs of their patients via telephone consultations, whereas 96% of clinicians felt similarly for video consultations (P = 0.002). A total of 33% and 57% of clinicians felt telephone and video consultations, respectively, were of the same standard as face-to-face consultations (P = 0.004). This study comprehensively assesses attitudes to IF telemedicine consultations. Our data show that a large proportion of patients and clinicians are satisfied with IF telephone and video consultations. However, there is an unmet need amongst clinicians for telemedicine training.

Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer.

Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer.

P-1118. Clinician knowledge, attitudes, and practices around empiric vancomycin use in the pediatric intensive care unit

Abstract Background Overuse of empiric vancomycin is common in pediatric intensive care units (PICU) despite a low prevalence of infections requiring vancomycin. Determinants of excess vancomycin prescribing are unknown. Our objective was to evaluate PICU clinician knowledge, attitudes, and practices regarding empiric vancomycin.Table 1.Demographic variables of survey respondents Methods We conducted a cross-sectional survey of PICU attendings, fellows, residents, and advanced practice providers in five tertiary care PICUs. The survey was distributed by email in August-September 2023. Survey items included Likert scale (1-5), ranking, and multiple-choice responses. Agree/Strongly Agree and Disagree/Strongly Disagree were collapsed to Agree and Disagree for analysis. Data were analyzed using descriptive statistics.Figure 1.Clinician attitudes about vancomycin use Results A total of 134 of 297 eligible clinicians (45%) answered the survey (Table 1). Knowledge of the spectrum of activity of vancomycin was low with only 14 of 117 (12%) respondents answering all questions correctly. Just over half of clinicians agreed that vancomycin overuse was a significant problem (72/134, 54%); this proportion varied from 0% to 65% across sites. Most clinicians (105/133, 79%) agreed that reducing vancomycin overuse would reduce antibiotic-associated adverse events. Clinicians had greater confidence in determining when vancomycin should be given to a patient with sepsis as compared to a hemodynamically stable patient with a fever (107/134, 80% vs 80/131, 61%). Respondents were most confident in determining when vancomycin could be stopped (113/134, 84% agreed) (Figure 1). Illness severity was the factor influencing the decision to start vancomycin ranked highest by the most respondents (55%), followed by suspected source of infection (19%), followed by patient history of methicillin-resistant Staphylococcus aureus (MRSA) (18%); local prevalence of MRSA was ranked highest least often (4%) (Figure 2).Figure 2.Factors influencing clinician decisions to administer empiric vancomycin Respondents ranked each possible factor 1-7 with 1 being the most influential factor in choosing to give vancomycin and 7 being the least influential. The blue shading reflects more influential factors and the gray shading reflects less influential factors. Conclusion Most PICU clinicians in this multi-site study felt confident about when to stop or start vancomycin, though many misunderstood the spectrum of vancomycin activity. Focusing stewardship efforts on improving clinician knowledge and supporting decision making, particularly for patients without sepsis, may address these barriers. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Interprofessional Debrief on Racism, Equity, and Microaggressions (I-DREAM): Using Simulation to Change Awareness, Attitudes, and Abilities Across an Institution.

Effective diversity, equity, and inclusion (DEI) education is imperative to combat bias across health care organizations. The authors evaluated the effectiveness of interprofessional, simulation-based DEI training in improving clinicians' awareness, attitudes, and abilities regarding bias, racism, inclusion, microaggressions, and equity in the workforce. From October 2021 to June 2022, interprofessional clinicians at Children's National Hospital in Washington, DC, completed the Interprofessional Debrief on Racism, Equity, and Microaggressions (I-DREAM) training. Participants underwent small group training that included debriefing prerecorded simulations depicting language barriers, microaggressions, and other biased interactions. They were offered optional surveys before training, after training, and at 3-month follow-up. Participants' awareness and attitudes of the events were assessed. Additional data were collected from monthly use of telephone interpreter services. A total of 1,811 interprofessional participants completed the I-DREAM training. Through user-generated codes, 759 presurveys and postsurveys and 276 presurveys and 3-month follow-up surveys were linked. Among these participants, 451 (60%) witnessed bias events before training and 629 (83%) after training (odds ratio [OR], 9.37; 95% CI, 5.77-15.22; P < .001), and 278 (37%) reported personally experiencing these events before training vs 496 (66%) after training (OR, 7.86; 95% CI 5.45-11.33; P < .001). Participants reporting confidence responding to bias events increased from 388 (45%) to 556 (73%) (OR, 3.28; 95% CI, 2.52-4.27; P < .001). At 3 months, 199 participants (72%) continued to express confidence in responding (OR, 3.98; 95% CI, 2.56-6.18; P < .001). Use of language interpretation increased during training (mean difference in calls per month, 261; 95% CI, 124-398; P < .001; mean difference in minutes per month, 2,249; 95% CI, 616-3,882; P = .009). I-DREAM training was associated with improved clinicians' awareness of bias events in the workplace, confidence in ability to respond to these events, and delivery of language-equitable care.

Health provider perspectives on establishing service linkages for treatment and follow-up from an Australian, web-based STI testing service: a qualitative study.

Background Web-based, testing for sexually transmitted infections (STI) is becoming increasingly available. However, treatment pathways from web-based services are often not well-coordinated, contributing to treatment delays and access gaps. This study investigated clinician perspectives on building service linkages with a new, web-based, STI testing service in Victoria, Australia. Methods We interviewed 16 clinicians from regional/outer metropolitan areas who are part of government-funded, primary care programs to strengthen sexual health services in Victoria. Interviews enquired about: clinician attitudes, considerations for managing referrals, compatibility with clinic systems, and broader policy/healthcare system factors. Results Clinicians were enthusiastic, perceived web-based services as complementary (not competition), and believed local treatment pathways were important for patient choice/access. They felt that administrative aspects of handling referrals from an online service could be managed without problems. To inform treatment, clinicians recommended that referral letters from the web-based service list all tests ordered, dates, and complete results. Tensions were raised regarding the utility and appropriateness of including treatment guidelines and pre-prepared prescriptions in referral letters. Respondents reported that most clinics did not stock injectable antibiotics, raising concerns by clinicians about potential treatment delays and privacy challenges related to patient-led procurement at pharmacies. Conclusions Our study suggests that clinicians are receptive to local treatment pathways being designed as part of web-based STI testing services, and strengthened service linkages could improve client access, particularly outside urban areas. Capacity-building and additional resourcing of local partner clinics may be needed to support decentralised, patient-centred treatment pathways.

The effect of psychiatric clerkship, educational phase, contact with mental illness and gender on stigma and mental health help-seeking attitude in medical students in Jordan

Background and aimsStigma is considered a significant barrier to help-seeking and it is more prominent in medical students. Studies exploring stigma and its impact on Attitude Towards Seeking Professional Psychiatric Help (ATSPPH) among medical students in Jordanian universities are scarce. In this paper, we aim to assess the level of stigma among Jordanian medical students and its relationship with help-seeking and other secondary factors.MethodsA cross-sectional study conducted through an online questionnaire on medical students in Jordan, the survey included validated psychometric tools Mental Health Clinicians Attitude 2 (MICA-2) and Attitude Towards Seeking Professional Psychiatric Help Short Form (ATSPPH-SF) in addition to sociodemographics. Stigma was analysed as a correlate of help-seeking using Spearman’s rank besides the non-parametric analysis of secondary factors.ResultsA total of 390 responses were analysed, 224 were females and 201 had experience with mental illness. There is an inverse relationship between stigma and ATSPPH p-value < .001. Jordanian medical students show relatively higher stigma compared to students from other nations. Females showed significantly less stigmatizing attitude p-value < .001 and more positive ATSPPH p-value < .001 compared to males. Individuals who encountered mental illness had significantly less stigma and more positive help-seeking behaviour compared to the opposite group. (p-value = .002 and p-value < .001) respectively. Completing a psychiatric clerkship had no impact on help-seeking.ConclusionMedical students in Jordan show a highly stigmatizing attitude compared with students from other nations. In parallel with the literature, females and students who experienced mental illness show less stigmatizing attitudes and more positive help-seeking behaviour.

Understanding Knowledge, Attitude, and Perception of Indian Clinicians in the Management of Resource-challenged Type 2 Diabetes Mellitus Patients in India - DESERVE India Expert Opinion: Part 1

Introduction: Type 2 diabetes mellitus (T2DM), once perceived as a condition prevalent among affluent elderly urban residents, now affects a more diverse demographic, including populations from less-privileged and rural communities. While providing optimal care, clinicians face challenges, such as the financial constraints of T2DM patients. This underscores the urgent need for affordable interventions to enhance patient outcomes and the necessity for a comprehensive understanding of clinician knowledge, attitudes, and perceptions (KAPs). The aim of this study was to develop a consensus of Indian clinicians to emphasize the need for awareness and access to high-quality, affordable interventional approaches for effectively managing resource-challenged T2DM patients in India. Methods: A mixed method study, including 590 clinicians and 60 subject matter experts, assessed their KAPs regarding managing &gt;18 years of adult resource-challenged (deserving) T2DM patients. A structured questionnaire gathered data on clinicians’ clinical and management practices. Four days in-depth interview with 60 subject matter experts also facilitated the expert opinion development process, ensuring a comprehensive and reliable study. Data were analyzed using SPSS Version 29, with statistical significance at P &lt; 0.05. Results: The findings of this study, based on the responses of 590 clinicians, are significant. About 38.64% of the clinicians encountered 1–5 resource-challenged T2DM patients daily, while 40.33% encountered 6–15 patients, reflecting a significant patient load. Concerning follow-up duration, 59.10% reported 1–3 months, highlighting the challenges in maintaining regular follow-ups. Over 80% agreed that these patients struggle to afford treatment and often miss follow-up appointments, seeking alternative therapies due to financial constraints, which can lead to suboptimal glycemic control (P &lt; 0.001). In addition, 82.00% agreed that high cost and lack of financial resources as the primary reason for medication non-adherence. The majority of clinicians agreed that “Glipizide + Metformin could be optimally used for these patients” (P &lt; 0.001). The expert panel identified financial constraints, lifestyle modification difficulties, and psychological challenges as key issues in managing resource-challenged T2DM patients in India. Conclusion: Clinicians and the expert panel agreed on several critical issues, including financial constraints and challenges in adopting lifestyle modifications to manage resource-challenged (deserving) T2DM patients. There is agreement on prescribing low-cost glucose-lowering medications with metformin and glipizide combinations to improve patient adherence and outcomes in resource-constrained settings.

URBAN-RURAL COMPARISONS OF ATTITUDE TOWARDS MENTAL ILLNESS AMONGST HEALTHCARE UNIVERSITY STUDENTS

Abstract: Objective: To examine and compare the differences in attitudes of healthcare university students towards mental illness from urban and rural backgrounds. Design: Cross-sectional study Place and duration of study: Study was conducted at Liaquat University of Medical &amp; Health Sciences Jamshoro, Sindh from October to December 2023. Methods: Sampling population were undergraduate students registered in different undergraduate healthcare programs (MBBS, BDS, DPT, Pharmacy, Nursing, Biomedical Engineering, BS MLT, BSRT, BS Forensic Chemistry/Biology and other allied departments), aged 18-27 years, of either gender, gave their consent of participation were included in the study. Data was collected with the help of online questionnaire. Mental Illness Clinician Attitude Scale (MICA-2 and 4) were employed to assess the healthcare student’s attitude towards mental illness. Results: There was female preponderance and mean age of subjects was 21.38 years ± SD 1.689. Majority of students were from MBBS and studying in final year and belonged to rural areas. The Median MICA score was 52. There was significant difference between scores of rural and urban students and statistically significant difference was noted among students from different departments and academic years. Conclusion: Overall attitude of healthcare university undergraduate students towards mental health illness is unsatisfactory. Whereas, the students from rural areas had poor attitude towards mental illness compared with those from the urban areas.

Using the Perspectives of Advanced Practice Providers to Design Strategies to Increase Engagement of Surgical Patients in Advance Care Planning.

Advanced practice providers (APPs) are essential members of surgical teams. We sought to understand the barriers and facilitators they perceive when participating in advanced care planning (ACP) discussions with patients and use this knowledge to design strategies to promote interprofessional ACP uptake for surgical services and potentially extend ACP discussions and documentation to more patients. ACP has been challenging to integrate into surgical practice despite being endorsed by national societies and payors as an essential aspect of caring for older adults. Using qualitative and quantitative methods, we surveyed and interviewed APPs at a single tertiary academic medical center. A previously validated Likert scale survey of clinician knowledge, attitudes, and experiences with ACP was adapted to include demographic information and details about practice experience. Of the 88 APPs who were sent our surveys, 46 (52%) responded. Eighty-eight percent of respondents believed APPs play an important role in ACP discussions, 80% believed that ACP information was helpful in guiding clinical care discussions, 71% expressed comfort with discussing ACP with patients, and 59% endorsed comfort with communicating a prognosis to patients. Twelve interviews yielded 3 main themes: (1) clinical and professional benefits of ACP; (2) barriers to APP involvement in ACP; (3) proposed interventions to integrate APPs into ACP. To increase surgical ACP uptake by APPs, data on proposed ACP interventions must focus on establishing a multi-disciplinary team-based workflow, addressing competing clinical demands, opportunities for additional education, and clarifying the scope of work.

Exploring Clinician Barriers and Enablers in Referring Patients to a Virtual Hospital for Acute Care

Background: Virtual hospitals offer a promising solution to alleviate pressures on traditional healthcare systems by providing acute care in patients' homes. Despite the implementation of a virtual hospital model in South Australia, referral rates remain below expectations. Aim: To explore clinician attitudes, beliefs, barriers, and enablers influencing referrals to a virtual hospital for acute care. Methods: A qualitative exploratory study was conducted using semi-structured interviews with nine clinicians who had experience referring patients to the virtual hospital. Data were analysed thematically using a grounded theory approach. Results: Four key themes emerged: (1) Complexity of the healthcare ecosystem leading to duplication and navigation challenges; (2) Ambiguity in patient selection criteria causing uncertainty in referrals; (3) Higher social complexity and non-medical care needs acting as barriers; (4) Interoperability issues and the need for effective change management. Conclusions: Addressing the identified barriers through refining referral pathways, clarifying eligibility criteria, enhancing support for patients with complex needs, and improving system interoperability could increase referral rates to the virtual hospital. Engaging clinicians in the co-design of virtual care models is essential for successful implementation.

Biased Language in Simulated Handoffs and Clinician Recall and Attitudes

Poor-quality handoffs can lead to medical errors when transitioning patient care. Biased language within handoffs may contribute to errors and lead to disparities in health care delivery. To compare clinical information recall accuracy and attitudes toward patients among trainees in paired cases of biased vs neutral language in simulated handoffs. Surveys administered from April 29 to June 15 and from July 20 to October 10, 2023, included 3 simulated verbal handoffs, randomized between biased and neutral, and measured clinical information recall, attitudes toward patients, and key takeaways after each handoff. Participants included residents in internal medicine, pediatrics, and internal medicine-pediatrics and senior medical students at 2 academic medical centers in different geographic regions of the US. Data were analyzed from November 2023 to June 2024. Each participant received 3 handoffs that were based on real handoffs about Black patients at 1 academic center. These handoffs were each randomized to either a biased or neutral version. Biased handoffs had 1 of 3 types of bias: stereotype, blame, or doubt. The order of handoff presentation was also randomized. Internal medicine and pediatrics residents received slightly different surveys, tailored for their specialty. Internal medicine-pediatrics residents received the pediatric survey. Medical students were randomly assigned the survey type. Each handoff was followed by a clinical information recall question, an adapted version of the Provider Attitudes Toward Sickle Cell Patients Scale (PASS), and 3 free-response takeaways. Of 748 trainees contacted, 169 participants (142 residents and 27 medical students) completed the survey (23% overall response rate), distributed across institutions, residency programs, and years of training (95 female [56%]; mean [SD] age, 28.6 [2.3] years). Participants who received handoffs with blame-based bias had less accurate information recall than those who received neutral handoffs (77% vs 93%; P = .005). Those who reported bias as a key takeaway of the handoff had lower clinical information recall accuracy than those who did not (85% vs 93%; P = .01). Participants had less positive attitudes toward patients per PASS scores after receiving biased compared with neutral handoffs (mean scores, 22.9 [3.3] vs 25.2 [2.7]; P < .001). More positive attitudes toward patients were associated with higher clinical information recall accuracy (odds ratio, 1.12; 95% CI, 1.02-1.22). In this survey study of residents and medical students, biased handoffs impeded accurate transfer of key clinical information and decreased empathy, potentially endangering patients and worsening health disparities. Handoff standardization is critical to addressing racial bias and improving patient safety.

Lessons Learned from a Global, Multisite Early Detection Program in Primary Care Implementation Program

AbstractDavos Alzheimer’s Collaborative Healthcare System Preparedness (DAC‐SP) aims to catalyze global healthcare system transformation, providing patients with quicker access to life‐changing innovations and therapies. Utilizing implementation science, the DAC‐SP Early Detection flagship program launched in 2021, engaging seven healthcare systems across six countries (Brazil, Jamaica, Japan, Mexico, Scotland, and the United States). The program's primary aim was to increase the rate of early detection of cognitive impairment by integrating commercially available digital cognitive assessments (DCAs) into primary care and other non‐specialty care settings. Patients with suspected cognitive decline based on the DCA were then offered a blood‐based biomarker (BBM) to determine the likelihood of amyloid presence in addition to customary follow‐up testing.Over the past two years, health system leaders from the early detection program were convened into a Community of Practice (CoP) that met monthly to discuss operational and clinical challenges, collaborate on solutions, and exchange learnings. As part of the CoP meetings, site leaders identified common implementation challenges for DCAs and BBMs in real‐world primary care settings. These challenges span various levels of health systems, including policy (e.g., reimbursement and procurement mechanisms, lack of guidance and consensus on workflow), the outer setting (e.g., availability/capacity of brain health expertise, lab infrastructure, fit with administrative systems), the inner setting (e.g., training and equipment required for blood draws, shipping logistics, administrative support) and understanding clinician knowledge, attitudes and behavior (e.g., level of comfort or experience with cognitive assessments, interpretation and disclosure of BBM results, access to training, task shifting resources, support from peers). Education about BBM specifications, use cases, and integration into clinical routines was essential in understanding the adoptability and scalability of BBMs in primary care settings.

Assessing Obstetrics and Gynecology (OBGYN) Clinicians' Knowledge, Practice, and Attitudes toward Anorexia Nervosa, Atypical Anorexia Nervosa, and Amenorrhea.

Assessing Obstetrics and Gynecology (OBGYN) Clinicians' Knowledge, Practice, and Attitudes toward Anorexia Nervosa, Atypical Anorexia Nervosa, and Amenorrhea.

Current attitudes to testicular prosthesis insertion during radical orchidectomy-An international perspective.

This study aimed to assess current international clinician practices, attitudes and barriers related to testicular prosthesis implantation in patients with testicular cancer at the time of radical inguinal orchidectomy. An international online survey of urologists who perform radical orchidectomy for testicular cancer was developed. The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10 February 2021 and 31 May 2021. The primary outcome was the proportion of urologists who always offered testicular prosthesis implantation to patients undergoing radical orchidectomy. Secondary outcomes included the reasons for not offering testicular prosthesis implantation. A total of 393 respondents took part in the online survey; of these, the majority were from the UK (66%), with the remaining international respondents (34%) from six different continents. Urologists (53%) reported they always offer testicular prosthesis implantation. Of those that offered testicular prosthesis implantation, 28% did so as a secondary procedure after radical orchidectomy, rather than the time of radical orchidectomy (72%). The most frequently selected reasons for not offering testicular prosthesis implantation included concerns about delaying chemotherapy (41%), infection (33%), impaired cosmesis (17%) and lack of availability (17%). Despite evidence confirming the safety and the psychological benefit of testicular prosthesis implantation during radical orchidectomy, current international practice suggests just over half of urologists always offer this to their patients. Increased clinician awareness of the low risk of complications and high patient satisfaction may act to reduce the perceived barriers in offering testicular prosthesis implantation.

Clinician attitudes towards adoption of evidence-based practice: a nationwide multiprofessional cross-sectional study of child and adolescent mental health services in Sweden.

Implementation of evidence-based practice (EBP) in child and adolescent mental health services (CAMHS) is a priority to improve service delivery and outcomes. Clinicians' EBP attitudes are likely to play a crucial role in implementation but are poorly understood. This study aimed to assess variation in EBP attitudes in a large national sample of CAMHS clinicians in Sweden, and to compare these findings to findings from the United States of America (USA). CAMHS clinicians (n = 799; 60% response rate) completed the Evidence-Based Practice Attitude Scale (EBPAS) and items from the Organizational Readiness for Change Scale (ORC) ahead of an EBP for depression implementation effort across Sweden. EBPAS scores were compared with the USA study. Predictors of global and specific attitudes (gender, age, working years, education, profession, perceived benefit of diagnosis and organizational readiness and type of service) were examined using simple and multiple linear regressions. Clinicians had positive attitudes towards EBP on the four-dimensional subscales of the EBPAS, somewhat more so than their American counterparts. Clinician and organizational characteristics were related to at least one attitudinal dimension in both models, with perceived utility of diagnosis being the strongest and most consistent predictor across dimensions and models. Results from this large-scale national study underscore the need to consider cultural, contextual, and individual variations in attitudes towards EBP when planning implementation efforts. Such efforts may need to be tailored to the working contexts, needs, and values of CAMHS clinicians, particularly their views on the utility of diagnosis.

Exploring Consumer and Clinician Attitudes towards Patient Reported Outcome Measures (PROMs) in an Australian Inpatient Musculoskeletal Rehabilitation Unit: A Qualitative Pilot Study

Exploring Consumer and Clinician Attitudes towards Patient Reported Outcome Measures (PROMs) in an Australian Inpatient Musculoskeletal Rehabilitation Unit: A Qualitative Pilot Study

Antimicrobial use at the end of life: a scoping review

ObjectiveTo examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial...

Clinicians' Knowledge, Attitudes, and Practices Regarding the Management of Functional Gastrointestinal Disorders With Neuromodulators and Psychological Treatment.

Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs. This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea. Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians' prescriptions had a lower rate (87.2% vs 64.2%, P < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, P < 0.001). Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.

Health Impact Assessment in Personalized Prevention: three applications on pharmacogenomic testing

Abstract Background In recent years, literature on the efficacy of genetic and genomic tests has expanded, yet the impact of personalized prevention programs that include such tests remains understudied. Our study aims to test the use of the Health Impact Assessment (HIA) framework, traditionally applied in non-health policy evaluation, to assess the impacts of personalized prevention policies. Methods We selected a policy mandating dihydropyrimidine dehydrogenase (DPYD) genetic test use before prescribing fluoropyrimidine for colorectal cancer (CRC) patients. Three HIAs are being conducted in Italy, Portugal, and Finland to assess the applicability across different contexts. The assessment involves literature review, comparative risk modeling, and stakeholder interviews. Three national steering committees, comprising representatives from key interest groups and experts, will evaluate evidence to gauge policy impacts and offer recommendations. Results The potential impacts identified include CRC patients’ outcomes, economic, organizational, patient experience, clinician workload, and equity. Preliminary results show a consensus in literature and national guidelines on the ability of the DPYD test to reduce adverse events and enhance the quality of life of CRC patients. However, the assessment reveals context-specific effects regarding equity, influenced by the prevalence of ethnic groups and variations in access to health services across regions. Differences also emerged on organizational aspects like the availability of resources such as laboratories and personnel. A lack of literature was observed on patient acceptability and clinician attitudes towards the test. Conclusions The use of HIA in personalized prevention might assist in identifying policy impacts often overlooked through the involvement of key interest groups in the assessment process. Such effort can further emphasize the significance of evaluating these programs while considering the geographical context. Key messages • Our study innovatively applies the Health Impact Assessment framework to evaluate personalized prevention programs in pharmacogenomic, addressing a critical research gap. • Preliminary findings underscore the importance of considering geographical factors in public health policy evaluation, highlighting nuanced context-specific effects.