Psychosocial information use for clinical decisions in diabetes care

J Am Med Inform Assoc. 2019 Aug 1;26(8-9):813-824. doi: 10.1093/jamia/ocz053.


Objective: There are increasing efforts to capture psychosocial information in outpatient care in order to enhance health equity. To advance clinical decision support systems (CDSS), this study investigated which psychosocial information clinicians value, who values it, and when and how clinicians use this information for clinical decision-making in outpatient type 2 diabetes care.

Materials and methods: This mixed methods study involved physician interviews (n = 17) and a survey of physicians, nurse practitioners (NPs), and diabetes educators (n = 198). We used the grounded theory approach to analyze interview data and descriptive statistics and tests of difference by clinician type for survey data.

Results: Participants viewed financial strain, mental health status, and life stressors as most important. NPs and diabetes educators perceived psychosocial information to be more important, and used it significantly more often for 1 decision, than did physicians. While some clinicians always used psychosocial information, others did so when patients were not doing well. Physicians used psychosocial information to judge patient capabilities, understanding, and needs; this informed assessment of the risks and the feasibility of options and patient needs. These assessments influenced 4 key clinical decisions.

Discussion: Triggers for psychosocially informed CDSS should include psychosocial screening results, new or newly diagnosed patients, and changes in patient status. CDSS should support cost-sensitive medication prescribing, and psychosocially based assessment of hypoglycemia risk. Electronic health records should capture rationales for care that do not conform to guidelines for panel management. NPs and diabetes educators are key stakeholders in psychosocially informed CDSS.

Conclusion: Findings highlight opportunities for psychosocially informed CDSS-a vital next step for improving health equity.

Keywords: clinical decision support; clinical decision-making; diabetes care; health equity; psychosocial factors; social determinants of health.

MeSH terms

  • Attitude of Health Personnel*
  • Clinical Decision-Making*
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / therapy*
  • Health Education
  • Humans
  • Interviews as Topic
  • Nurses
  • Nutritionists
  • Physicians
  • Social Determinants of Health
  • Socioeconomic Factors*
  • Stress, Psychological*
  • Surveys and Questionnaires