Results of a Patient-oriented Second Opinion Program in Germany Shows a High Discrepancy Between Initial Therapy Recommendation and Second Opinion

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2020 Mar 21

PMID 32192450

Citations 6

Authors

Jan Weyerstrass

Barbara Prediger

Edmund Neugebauer

Dawid Pieper

Affiliations

Soon will be listed here.

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.

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References

van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J . Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy. 2001; 6(4):195-201. DOI: 10.1258/1355819011927486. View

Birkmeyer J, Reames B, McCulloch P, Carr A, Campbell W, Wennberg J . Understanding of regional variation in the use of surgery. Lancet. 2013; 382(9898):1121-9. PMC: 4211114. DOI: 10.1016/S0140-6736(13)61215-5. View

Ware Jr J, Gandek B, Kosinski M, Aaronson N, Apolone G, Brazier J . The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998; 51(11):1167-70. DOI: 10.1016/s0895-4356(98)00108-5. View

Vashitz G, Pliskin J, Parmet Y, Kosashvili Y, Ifergane G, Wientroub S . Do first opinions affect second opinions?. J Gen Intern Med. 2012; 27(10):1265-71. PMC: 3445697. DOI: 10.1007/s11606-012-2056-y. View

Mukaka M, White S, Terlouw D, Mwapasa V, Kalilani-Phiri L, Faragher E . Is using multiple imputation better than complete case analysis for estimating a prevalence (risk) difference in randomized controlled trials when binary outcome observations are missing?. Trials. 2016; 17:341. PMC: 4957845. DOI: 10.1186/s13063-016-1473-3. View

Lenza M, Buchbinder R, Staples M, Dos Santos O, Brandt R, Lottenberg C . Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study. BMC Musculoskelet Disord. 2017; 18(1):354. PMC: 5561586. DOI: 10.1186/s12891-017-1712-0. View

Martin S, Shwartz M, Whalen B, DArpa D, Ljung G, Thorne J . Impact of a mandatory second-opinion program on medicaid surgery rates. Med Care. 1982; 20(1):21-45. DOI: 10.1097/00005650-198201000-00003. View

Mellink W, Dulmen A, Wiggers T, Spreeuwenberg P, Eggermont A, Bensing J . Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. J Clin Oncol. 2003; 21(8):1492-7. DOI: 10.1200/JCO.2003.12.058. View

Shmueli L, Davidovitch N, Pliskin J, Balicer R, Hekselman I, Greenfield G . Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Isr J Health Policy Res. 2017; 6(1):67. PMC: 5721599. DOI: 10.1186/s13584-017-0191-y. View

10.

Greenfield G, Pliskin J, Feder-Bubis P, Wientroub S, Davidovitch N . Patient-physician relationships in second opinion encounters - the physicians' perspective. Soc Sci Med. 2012; 75(7):1202-12. DOI: 10.1016/j.socscimed.2012.05.026. View

11.

Meyer A, Singh H, Graber M . Evaluation of outcomes from a national patient-initiated second-opinion program. Am J Med. 2015; 128(10):1138.e25-33. DOI: 10.1016/j.amjmed.2015.04.020. View

12.

Widmer M, Matter P, Staub L, Schoeni-Affolter F, Busato A . Regional variation in orthopedic surgery in Switzerland. Health Place. 2009; 15(3):761-8. DOI: 10.1016/j.healthplace.2008.12.009. View

13.

Feinberg A, Porter J, Saskin R, Rangrej J, Urbach D . Regional variation in the use of surgery in Ontario. CMAJ Open. 2015; 3(3):E310-6. PMC: 4593463. DOI: 10.9778/cmajo.20150014. View

14.

Payne V, Singh H, Meyer A, Levy L, Harrison D, Graber M . Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc. 2014; 89(5):687-96. DOI: 10.1016/j.mayocp.2014.02.015. View

15.

Ruetters D, Keinki C, Schroth S, Liebl P, Huebner J . Is there evidence for a better health care for cancer patients after a second opinion? A systematic review. J Cancer Res Clin Oncol. 2015; 142(7):1521-8. DOI: 10.1007/s00432-015-2099-7. View

16.

Swart E, Gothe H, Geyer S, Jaunzeme J, Maier B, Grobe T . [Good Practice of Secondary Data Analysis (GPS): guidelines and recommendations]. Gesundheitswesen. 2015; 77(2):120-6. DOI: 10.1055/s-0034-1396815. View

17.

McPherson K, WENNBERG J, Hovind O, Clifford P . Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982; 307(21):1310-4. DOI: 10.1056/NEJM198211183072104. View

18.

Pieper D, Hess S, Mathes T . [Compilation of Second Opinion Programs in the German Statutory Health Insurance]. Gesundheitswesen. 2017; 80(10):859-863. DOI: 10.1055/s-0043-105576. View

19.

Wagner T, Wagner L . Who gets second opinions?. Health Aff (Millwood). 1999; 18(5):137-45. DOI: 10.1377/hlthaff.18.5.137. View

20.

Ali J, Pieper D . [Limited Data for Second Opinion Programs: a Systematic Review]. Gesundheitswesen. 2016; 79(10):871-874. DOI: 10.1055/s-0042-108586. View