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These analyses did not include two further factors which may be associated with decision appropriateness: patient group, and whether appropriate decisions involved the GPs performing an action (e.g. ordering a necessary test) or not performing an action (e.g. not prescribing unnecessary antibiotics).
However, it was possible to pool the data from the studies which assessed decision appropriateness, by focussing on the number of decisions deemed appropriate.
Decision appropriateness is then assessed by comparing the decisions to an appropriate decision defined by a standard such as a clinical guideline.
As discussed, it was not possible to calculate numbers of appropriate decisions for 28 of the 66 studies which assessed decision appropriateness, so we were unable to aggregate all the data.
The categories of decision appropriateness assessment method in Table 1 reflect the methods used to determine appropriate and inappropriate decisions.> -wrap-foot> Note: ***p < .001.001
The results also indicate that variation in difficulty might be important for decision appropriateness: specifically, greater decision difficulty may result in lower likelihood of an appropriate clinical decision being made.
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However, one participant (ID1, GP) explained how hospital clinicians were often unaware of the admitting circumstances and would frequently have limited information to base their decision of appropriateness on, further highlighting the communication problems between primary and secondary care providers.
Decisions regarding appropriateness were made separately by two of the authors (GD and validated by BS).
These reports suggested that some physicians go beyond explicit, objective assessments and use more intuitive judgments and decisions about appropriateness of opioids.
CRP may be favoured over PCT courses in decisions on appropriateness and duration of antibiotic treatment, whereas PCT rather than CRP courses may help predicting complications such as bloodstream infection, septic shock and mortality.
Scenario-based research into GPs' decisions rarely considers the relationship between decision difficulty and appropriateness: more research is needed to identify the specific factors which influence decision difficulty and appropriateness, to specify the relationship between decision difficulty and appropriateness, and ultimately to improve the appropriateness of clinical decisions made by GPs.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com