Markus Gulich | Search PubMed

PubMed2006

[A complex process: decision-making in general practice: 117 structured case analyses].

BACKGROUND: A variety of factors seem to play a role in decision-making in general practice. To describe the complexity of this process a vague symptom with a broad spectrum of possible causes and outcomes was chosen: dizziness. Aim of this study was to provide a conceptual framework to describe and assess the complex reasoning process of general practitioners. METHODS: 22 GPs were interviewed about the patients seeking help for dizziness. The semi-structured focussed interviews were qualitatively analysed by consensus method. RESULTS: By 117 structured case analyses factors with influence on the decision-making process were identified and assigned to 7 different domains. Concepts described in literature were found as well as less well-known or even not accepted motives. CONCLUSIONS: Influenced by a variety of parameters, the decision-making process in general practice is complex. It is necessary to be aware of them to be able to deal with them.

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A comparison of different strategies to collect standard gamble utilities.

OBJECTIVE: The authors performed a methodological comparison of the usual standard gamble with methods that could also be used in mailed questionnaires. METHODS: Ninety-two diabetic patients valued diabetes-related health states twice. In face-to-face interviews, the authors used an iterative standard gamble (ISG) in which the probabilities were varied in a ping-pong manner and a self-completion method (SC) with top-down titration as search procedure (SC-TD) in 2 independent subsamples of 46 patients. Three months later, all patients received a mailed questionnaire in which the authors used the self-completion method with bottom-up (SCBU) and SC-TD as search procedures. RESULTS: ISG and SCTD showed feasibility and consistency in the interviews. The ISG resulted in significantly higher utilities than the SC-TD. Two thirds of the mailed questionnaires provided useful results indicating some problems of feasibility. Utilities measured by SC-BU and SC-TD did not differ significantly showing procedural invariance. Further, patients indicated ambivalence when given the choice not to definitely state their preferences. CONCLUSIONS: The results show that different strategies to collect standard gamble utilities can yield different results. Compared with the usually applied ISG, the SC method is feasible in interviews and provides a consistent alternative that is less costly when used in mailed questionnaires, although its practicability has to be improved in this later setting.

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