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Judgment and decision-making in prescriptive practice

Jason E Vogler, University of Nebraska - Lincoln


The purpose of this study was to develop, test and pilot an experimental paradigm for evaluating clinical judgment and decision-making (JDM) pertinent to the prescription of antipsychotic medication. Several practice guidelines have been developed for prescribing antipsychotic medications to control clinical practice, lower costs, and assist clinicians in making appropriate clinical decisions. The guidelines consistently support antipsychotic monotherapy wherever possible. However, despite widespread publication and endorsement of the guidelines, there is substantial evidence that prescribers do not adhere to them. Thus the question remains, what decisions and judgments do prescribers perform when providing treatment? Using a JDM protocol adapted from cognitive and social psychology, psychiatrists and psychiatric residents were asked to evaluate a hypothetical client and recommend treatment. Participants were also asked questions about themselves (e.g., age, gender, type of training, years of clinical practice). The central hypothesis was that different patient factors, provider factors, and contextual factors would provide a reliable way to predict the use of antipsychotic polypharmacy. Additionally, secondary hypotheses included relationships among perceptions of provider nonadherence and practice variation. Partial support for both general hypotheses was obtained. Results suggest that patient, provider, and contextual factors were not able to significantly predict polypharmacy. Provider adherence with medication algorithms was related to their familiarity with the algorithms. In addition, use of medication algorithms was dependent upon providers' perceptions of their usefulness in clinical practice. This is the first known study to extensively and empirically investigate judgment and decision-making in prescriptive practice.^

Subject Area

Health Sciences, Mental Health|Psychology, Clinical

Recommended Citation

Vogler, Jason E, "Judgment and decision-making in prescriptive practice" (2007). ETD collection for University of Nebraska - Lincoln. AAI3259075.