Lay Summary Mental health problems among children and youths are common and have impacts, not only on the person affected but also on families and communities. They are often not recognized and... Show moreLay Summary Mental health problems among children and youths are common and have impacts, not only on the person affected but also on families and communities. They are often not recognized and acted upon by primary care providers (PCPs), such as general practitioners. This may be due to a lack of confidence in talking to young people or insufficient knowledge about mental health problems. PCPs make decisions about managing or referring these problems to mental health specialists, which can be assisted through clinical decision support methods (CDSMs). CDSMs can be divided into electronic and non-electronic. This study provided an overview of both types of CDSMs. We focused on the capabilities of CDSMs and how they help PCPs in their decision-making. More than half of the reviewed CDSMs were electronic CDSMs; several CDSMs involved telecommunication between PCPs and mental health specialists. Two of the CDSMs comprised a combination of components of both types of CDSMs. CDSMs offered patients more information about their health while providing PCPs with suggestions for their decision-making.Background Mental health disorders among children and youths are common and often have negative consequences for children, youths, and families if unrecognized and untreated. With the goal of early recognition, primary care physicians (PCPs) play a significant role in the detection and referral of mental disorders. However, PCPs report several barriers related to confidence, knowledge, and interdisciplinary collaboration. Therefore, initiatives have been taken to assist PCPs in their clinical decision-making through clinical decision support methods (CDSMs). Objectives This review aimed to identify CDSMs in the literature and describe their functionalities and quality. Methods In this review, a search strategy was performed to access all available studies in PubMed, PsychINFO, Embase, Web of Science, and COCHRANE using keywords. Studies that involved CDSMs for PCP clinical decision-making regarding psychosocial or psychiatric problems among children and youths (0-24 years old) were included. The search was conducted according to PRISMA-Protocols. Results Of 1,294 studies identified, 25 were eligible for inclusion and varied in quality. Eighteen CDSMs were described. Fourteen studies described computer-based methods with decision support, focusing on self-help, probable diagnosis, and treatment suggestions. Nine studies described telecommunication methods, which offered support through interdisciplinary (video) calls. Two studies described CDSMs with a combination of components related to the two CDSM categories. Conclusion Easy-to-use CDSMs of good quality are valuable for advising PCPs on the detection and referral of children and youths with mental health disorders. However, valid multicentre research on a combination of computer-based methods and telecommunication is still needed. Show less
Boom, V.E.A.; Kamp, L.T. van der; Zuilen, A.D. van; Ranitz, W.L. de; Bos, W.J.; Jellema, W.T.; ... ; Kaasjager, K. 2020
Introduction eConsultation in nephrology is an innovative way for general practitioners (GPs) to consult a nephrologist. Studies have shown that questions from GPs can be answered and intended... Show moreIntroduction eConsultation in nephrology is an innovative way for general practitioners (GPs) to consult a nephrologist. Studies have shown that questions from GPs can be answered and intended referrals can be avoided by eConsultation. However, follow-up data are lacking. The primary aim of this study was therefore to assess whether patients for whom a referral to the outpatient clinic of a medical specialist was avoided in the short term were not then referred for the same problem within one year after the eConsultation. Methods All eConsultations sent between June 2017 and April 2018 to seven nephrologists in three different hospitals in The Netherlands were included. Exclusion criteria were duplications and missing data on follow-up. Data were obtained from the eConsultation application forms and from GP medical records. Results A total of 173 eConsultations were included. Of the 32 patients for whom a referral was initially prevented, 91% (95% confidence interval 75-98) had not been referred to a specialist for the same problem within one year after the eConsultation. Discussion eConsultation in the field of nephrology can prevent referrals in the long term. It can therefore contribute to a more modern and efficient health-care system in which chronic care is provided by GPs in close proximity to patients, while specialist support is easily available and accessible through eConsultation when necessary. Show less
