Date of Conferral

2020

Degree

Ph.D.

School

Psychology

Advisor

Patti L. Barrows

Abstract

Gaps between treatment guidelines and medical decisions persist despite interventions with physicians, which are mostly atheoretical. The purpose of this retrospective cross-sectional study was to compare atheoretical and theory-based logistic regression models of a binary outcome: potentially unsafe prescribing of attention-deficit hyperactivity disorder (ADHD) medications to adults. Social cognitive theory and self-determination theory provided the framework for the study. Predictors were framed as social cognitive theoretical constructs: knowledge (e.g., physician specialty) and environmental influence (e.g., interventions). Atheoretical hypotheses were based on legislation mandating meaningful use of electronic health records and computerized decision support (CDS). Theory-based hypotheses were derived from literature on cognition in medicine and on the controlled motivation construct in self-determination theory. Research questions addressed associations of CDS and meaningful use with the outcome and fit of competing models. The sample included office-based physician visits made by patients aged > 17 years with ADHD (n = 810) or potentially unsafe medical conditions (n = 9,101), recorded in a U.S. database in 2014–2016. Findings for the atheoretical model were reduced odds of the outcome with CDS, and nonsignificant improvement in model fit using theory. Supporting the self-determination theory-based hypothesis, odds were increased with meaningful use. This study adds to research suggesting autonomy as a core issue in medicine. Positive social change may result from psychology-based strategies to empower physicians through participation in developing clinically relevant information systems.

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