חוות דעת רפואית שניה בישראל: מי, כמה ולמה?
לצפיה במצגת לחצו כאן
Background: Second opinion (SO) is common in medical practice and can reduce unnecessary risks and costs. To date, there is no population-based estimation of how many people seek SOs, what the characteristics of SO seekers are and their reasons for seeking SOs.
Objectives: The current study aims t o estimate the utilization of SO in Israel and to identify demographic and clinical predictors affecting SO utilization, within the HMOs and the private sector. This study also aims to explore the reasons for seeking SO s and to evaluate inequalities in accessibility to SO s in the private and the public systems.
Methods: The current study includes two research methodologies: electronic medical records database analysis (n=1,392,907) and a cross-sectional national telephone survey with a representative sample of the general Israeli population (n=848, response rate=62%). In the electronic medical records database analysis, we linked consultations with specialists at community secondary care and private consultations using claims data. We developed a time-sensitive algorithm that identified potential SO instances. In both methods, we predicted the characteristics of SO seekers using multivariate logistic regressions.
Results: The electronic medical records analysis and the survey findings were highly consistent, showing that about one sixth ( 15 % in the electronic medical records vs. 17.2% in the survey) of a general population sought a SO, mostly from orthopedic surgeons. Women, native-born and established immigrants, people living in central urban areas or close to central urban areas, p eople with chronic conditions , and those who perceived their health status as not very good, were more likely to seek SOs than others. The common reasons for seeking SOs included doubts about diagnosis or treatment (38.1%), search for a sub-specialty expert (19.4%), or dissatisfaction with communication with the first physician (19.2%). The main r eason for seeking a SO from physicians working in the private health sector was the assumption that they are more professional (4 5 . 7 % ). Yet, those patients were neither more satisfied (p=0.45), nor felt improvement in their perceived clinical outcomes ( p= 0.37).
Conclusions: A considerable amount of people sought a SO. Certain patient profiles tended to seek SOs more than others. Such utilization patterns are important to devise policy regarding SOs, due to their implications on expenditure, policy, clinical outcomes, and patient satisfaction. Further studies are needed to better understand how to integrate SO in healthcare systems, improve access and reduce misuse.