Improving Therapeutic Decision-Making During Active Clinical Practice

The ultimate goal of Laura Esmail’s research is to improve the management of medication use and patient outcomes. Studies estimate that 4.3% of hospital admissions in industrialized countries are due to preventable adverse outcomes of drug therapy. To begin to address this problem, Laura developed and tested a decision-making network aimed to improve physicians’ drug therapy decision-making. The conceptual framework of this network was based on the theory of cognitive apprenticeships: the process of understanding concepts through engaging in authentic activities and actual practice. Through linking family physicians with clinical pharmacists using cellular-telephone instant group conferencing, Laura attempted to create a continuous, contextual, social learning environment in which therapeutic expertise and experience could be shared and acquired at the time of patient care decision-making. This network ultimately aimed to facilitate the collaborative decision-making process that often takes place between health care professionals during hospital medical rounds. Results of her study concluded that cellular-telephone instant group conferencing between family physicians and clinical pharmacists is a useful method for influencing and assisting with drug therapy decisions at the time of patient care decision-making. Further modifications to the network are necessary before feasibility can be fully assessed. This work is an important contribution towards the understanding of decision-making systems that can improve drug related morbidity and mortality and help advance patient care.