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The aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach.
Patient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics. We identified five key themes (anxiety, weighting, agenda, resource and experience), which were constructed into an acronym ‘AWARE’.
AWARE provides a framework to make explicit drivers for decision-making that are often implicit. Incorporating these drivers into reflective practice will help staff be more mindful of undue influences and result in improved clinical decisions.
No study has so far explored differences in discrimination reported by
people with major depressive disorder (MDD) across countries and
To (a) compare reported discrimination across different countries, and
(b) explore the relative weight of individual and contextual factors in
explaining levels of reported discrimination in people with MDD.
Cross-sectional multisite international survey (34 countries worldwide)
of 1082 people with MDD. Experienced and anticipated discrimination were
assessed by the Discrimination and Stigma Scale (DISC). Countries were
classified according to their rating on the Human Development Index
(HDI). Multilevel negative binomial and Poisson models were used.
People living in ‘very high HDI’ countries reported higher discrimination
than those in ‘medium/low HDI’ countries. Variation in reported
discrimination across countries was only partially explained by
individual-level variables. The contribution of country-level variables
was significant for anticipated discrimination only.
Contextual factors play an important role in anticipated discrimination.
Country-specific interventions should be implemented to prevent
discrimination towards people with MDD.
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