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Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion.

ABSTRACT: BACKGROUND:As of 2015, second opinions are legally implemented in Germany. However, empirical results from German second opinion programs are lacking. The aim of this study was to examine several aspects within a population of a German second opinion program. METHODS:Study population consisted of patients who sought a second opinion in the period from August 2011 to December 2016. Multivariate logistic regression and ANOVA were used to examine differences in patient characteristics, differentiated by agreement of initial therapy recommendation and second opinion. Follow-up points for patient satisfaction and HRQoL were defined at 1, 3 and 6?months after obtaining the second opinion. RESULTS:Total number of patients who sought a second opinion was 1414. Most common indications concerned the knee (37.3%), spine (27.3%), hip (11.5%) and shoulder (10.1%). The independent specialists did not confirm the initial therapy recommendations in two out of three cases. The type of indication influenced the agreement between initial therapy recommendation and the second opinion significantly (p?=?0.035). The second opinion and the offered service was highly valued by the patients (89%). CONCLUSIONS:The second opinion offers patients the possibility to confirm a medical indication independently and support patients in their decision making process. Reasons for the large discrepancy between initial therapy recommendation and second opinion should be addressed in future research.

SUBMITTER: Weyerstraß J

PROVIDER: S-EPMC7083019 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion.

Weyerstraß Jan J Prediger Barbara B Neugebauer Edmund E Pieper Dawid D

BMC health services research 20200320 1

<h4>Background</h4>As of 2015, second opinions are legally implemented in Germany. However, empirical results from German second opinion programs are lacking. The aim of this study was to examine several aspects within a population of a German second opinion program.<h4>Methods</h4>Study population consisted of patients who sought a second opinion in the period from August 2011 to December 2016. Multivariate logistic regression and ANOVA were used to examine differences in patient characteristic ...[more]

PMID: 32192450

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Project description:BackgroundIn this study we proposed a new strategy to measure cost-effectiveness of second opinion program on spine surgery, using as measure of effectiveness the minimal important change (MIC) in the quality of life reported by patients, including the satisfaction questionnaire regarding the treatment and direct medical costs.MethodsRetrospective analysis of patients with prior indication for spine surgery included in a second opinion program during May 2011 to May 2019. Treatment costs and outcomes were compared considering each patients' recommended treatment before and after the second opinion. Costs were measured under the perspective of the hospital, including hospital stay, surgical room, physician and staff fees and other costs related to hospitalization when surgery was performed and physiotherapy or injection costs when a conservative treatment was recommended. Reoperation costs were also included. For comparison analysis, we used data based on our clinical practice, using data from patients who underwent the same type of surgical procedure as recommended by the first referral. The measure of effectiveness was the percentage of patients who achieved the MIC in quality of life measured by the EQ-5D-3 L 2 years after starting treatment. An incremental cost-effectiveness ratio (ICER) was calculated.ResultsBased upon the assessment of 1,088 patients that completed the entire second opinion process, conservative management was recommended for 662 (60.8%) patients; 49 (4.5%) were recommended to injection and 377 (34.7%) to surgery. Complex spine surgery, as arthrodesis, was recommended by second opinion in only 3.7% of cases. The program resulted in financial savings of -$6,705 per patient associated with appropriate treatment indication, with an incremental effectiveness of 0.077 patients achieving MIC when compared to the first referral, resulting in an ICER of $-87,066 per additional patient achieving the MIC, ranging between $-273,016 and $-41,832.ConclusionAfter 2 years of treatment, the second opinion program demonstrated the potential for cost-offsets associated with improved quality of life.

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Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion.

Publications

Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion.

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