Are patients’ preferences regarding the place of treatment heard and addressed at the point of referral: an exploratory study based on observations of GP-patient consultations

BMC Family Practice

Research Article

Janneke Noordman¹  Jany J D J M Rademakers¹  Johan A Sonderkamp¹  Aafke Victoor¹  Sandra van Dulmen²  Roland D Friele³  Diana M J Delnoij⁴ 

[1] NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500, BN Utrecht, The Netherlands;NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500, BN Utrecht, The Netherlands;Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands;Department of Health Science, Buskerud University College, Drammen, Norway;NIVEL, the Netherlands Institute for Health Services Research, P.O. Box 1568, 3500, BN Utrecht, The Netherlands;Tilburg University, School of Social and Behavioural Sciences, Tranzo, P.O. Box 90153, 5000, LE Tilburg, The Netherlands;Tilburg University, School of Social and Behavioural Sciences, Tranzo, P.O. Box 90153, 5000, LE Tilburg, The Netherlands;Health Care Insurance Board (CVZ), Quality Institute, P.O. Box 320, 1110, AH Diemen, The Netherlands;

关键词: Choice behaviour;    Patient freedom of choice laws;    Healthcare providers;    Healthcare reform;    Communication;    General practitioners;    Referral;    Physicians’ role;   

DOI  :  10.1186/1471-2296-14-189

 received in 2013-10-08, accepted in 2013-12-04,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundToday, in several north-western European countries, patients are encouraged to choose, actively, a healthcare provider. However, patients often visit the provider that is recommended by their general practitioner (GP). The introduction of patient choice requires GPs to support patients to be involved, actively, in the choice of a healthcare provider. We aim to investigate whether policy on patient choice is reflected in practice, i.e. what the role of the patient is in their choices of healthcare providers at the point of referral and to what extent GPs’ and patients’ healthcare paths influence the role that patients play in the referral decision.MethodsIn 2007–2008, we videotaped Dutch GP-patient consultations. For this study, we selected, at random, 72 videotaped consultations between 72 patients and 39 GPs in which the patient was referred to a healthcare provider. These were analysed using an observation protocol developed by the researchers.ResultsThe majority of the patients had little or no input into the choice of a healthcare provider at the point of referral by their GP. Their GPs did not support them in actively choosing a provider and the patients often agreed with the provider that the GP proposed. Patients who were referred for diagnostic purposes seem to have had even less input into their choice of a provider than patients who were referred for treatment.ConclusionsWe found that the GP chooses a healthcare provider on behalf of the patient in most consultations, even though policy on patient choice expects from patients that they choose, actively, a provider. On the one hand, this could indicate that the policy needs adjustments. On the other hand, adjustments may be needed to practice. For instance, GPs could help patients to make an active choice of provider. However, certain patients prefer to let their GP decide as their agent. Even then, GPs need to know patients’ preferences, because in a principal-agent relationship, it is necessary that the agent is fully informed about the principal’s preferences.

【 授权许可】

Unknown   
© Victoor et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.