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Eliciting patient views on choosing the next available surgeon to reduce waiting times for joint replacement surgery: on the need to consider individual patient preferences and information needs.

Barbara Conner-Spady, Deborah Marshall, Eric Bohm, Michael Dunbar, Cy Frank, Gillian Hawker, Tom Noseworthy

Abstract


Rationale, aims, and objectives:  The objective is to understand patient views on surgeon choice when being referred for joint replacement; do they prefer referral to the next available surgeon for a shorter waiting time or do they prefer their own choice of surgeon? What factors guide this decision and what information would patients find useful when deciding?

Methods:  Seven focus groups were held in four Canadian cities.  Participants had been either referred to or seen by an orthopaedic surgeon for hip or knee replacement surgery.  The method of analysis was qualitative thematic analysis.

Results:  There were 50 participants, 66% female, 60% knee replacements and the average age was 66 years (SD 12).  68% were on a waiting list for surgery and 32% were undecided about surgery.  Although patients varied in their views, many wanted some choice in their decision about a surgeon.  If patients were in severe pain, they were more likely to accept the idea of referral to the next available surgeon.  Other considerations were the recommendation of their family physician, surgeon reputation and confidence in the surgeon.  Although some patients wanted access to patient outcome data and satisfaction data, others were skeptical of data and the interpretation of statistics. 

Conclusion:  Patient views on referral to the next available surgeon are relevant to initiatives aimed at improving access to care, such as pooled surgeon waiting lists.  If implemented, waiting time is not the only important factor for patients.  Individual patient preferences and information needs must also be considered, given their pivotal significance in the development of person-centered approaches in clinical care.   


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References


. Ramchandani, M., Mirza, S., Sharma, A. and Kirkby, G. (2002). Pooled cataract waiting lists: views of hospital consultants, general practitioners and patients. Journal of the Royal Society of Medicine 95 (12), 598-600.

. Singh, N., Brooke-Cowden, G.L., Whitehurst, C., Smith, D. and Senior J. (2005). The Auburn Elective Surgery Pilot Project. Australia and New Zealand Journal of Surgery 75 (9), 768-775.

. Bungard, T.J., Smigorowsky, M.J., Lalonde, L.D., Hogan, T., Doliszny, K.M., Gebreyesus, G., Garg, S. and Archer, S.L. (2009). Cardiac EASE (Ensuring Access and Speedy Evaluation) - the impact of a single-point-of-entry multidisciplinary outpatient cardiology consultation program on wait times in Canada. Canadian Journal of Cardiology 25 (12), 697-702.

. Cipriano, L.E., Chesworth, B.M., Anderson, C.K. and Zaric, G.S. (2008). An evaluation of strategies to reduce waiting times for total joint replacement in Ontario. Medical Care 46 (11), 1177-1183.

. Hanning, M. and Spangberg, U.W. (2000). Maximum waiting time - a threat to clinical freedom? Implementation of a policy to reduce waiting times. Health Policy 52 (1), 15-32.

. Dixon, A., Robertson, R. and Bal, R. (2010). The experience of implementing choice at point of referral: a comparison of the Netherlands and England, Health Economics, Policy, and Law 5 (3), 295-317.

. Canadian Institute for Health Information. Wait time tables - a comparison by province (2010). http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2810_E&cw_topic=2810&cw_rel=AR_1909_E . 6-7-2010.

. WCWL. (2005). Towards establishing evidence-based benchmarks for acceptable waiting times for joint replacement surgery. http://www.wcwl.ca/library/cihr_synthesis_reports/ . 10-10-2010.

. Postl, B. (2006). Final report of the federal advisor on wait times. http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2006-wait-attente/index-eng.php . Health Canada. 6-7-2010.

. MacLeod, A.M., Gollish, J., Kennedy, D., McGlasson, R. and Waddell, J. (2009). Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership. Healthcare Quarterly 12 (2), 56-65.

. Bichel, A., Erfle, S., Wiebe, V., Axelrod, D. and Conly, J. (2009). Improving patient access to medical services: preventing the patient from being lost in translation. Healthcare Quarterly 13 Spec No:61-68.

. Leach, P., Rutherford, S.A., King, A.T. and Leggate, J.R. (2004). Generic waiting lists for routine spinal surgery. Journal of the Royal Society of Medicine 97 (3), 119-120.

. Patton, M.Q. (2002). Qualitative evaluation and research methods. 3rd ed. Thousand Oaks, CA: Sage.

. Thomas, D.R. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation 27 (2), 237-246.

. NVivo 8 (2008). Doncaster, Victoria, Australia: QSR International Pty Ltd.

. Stewart, D.W. and Shamdasani, P,N. (1990). Focus groups Theory and Practice. Newbury Park, CA: Sage.

. Burge, P., Devlin, N., Appleby, J., Rohr, C. and Grant, J. (2004). Do patients always prefer quicker treatment? : a discrete choice analysis of patients' stated preferences in the London patient choice project. Applied Health Economics and Health Policy 3 (4),183-194.

. Conner-Spady, B., Sanmartin, C., Johnston, G., McGurran, J. and Noseworthy, T. (2008). Willingness of patients to change surgeons for a shorter waiting time for joint arthroplasty. Canadian Medical Association Journal 179 (4), 327-332.

. Birk, H.O. and Henriksen, L.O. (2006). Why do not all hip- and knee patients facing long waiting times accept re-referral to hospitals with short waiting time? Questionnaire study. Health Policy 77 (3), 318-325.

. Brouwer, W., van Exel, J., Hermans, B. and Stoop, A. (2003). Should I stay or should I go? Waiting lists and cross-border care in the Netherlands. Health Policy 63 (3), 289-298.

. Moser, A., Korstjens, I., van der Weijden, T. and Tange, H. (2010). Patient's decision making in selecting a hospital for elective orthopaedic surgery. Journal of Evaluation in Clinical Practice 16 (6), 1262-1268.

. Fotaki, M. (1999). The impact of market oriented reforms on choice and information: a case study of cataract surgery in outer London and Stockholm. Social Science & Medicine 48 (10), 1415-1432.

. Thomson, S. and Dixon, A. (2006). Choices in health care: the European experience. Journal of Health Services Research & Policy 11 (3), 167-171.

. Magee, H,, Davis, L.J. and Coulter A. (2003). Public views on healthcare performance indicators and patient choice. Journal of the Royal Society of Medicine 96 (7), 338-342.

. Ovretveit, J. (1996). Informed choice? Health service quality and outcome information for patients. Health Policy 37 (2), 75-90.

. Bunge, M., Muhlhauser, I. and Steckelberg, A. (2010). What constitutes evidence-based patient information? Overview of discussed criteria. Patient Education and Counseling 78 (3), 316-328.

. Marshall, M.N., Shekelle, P.G., Leatherman, S. and Brook, R.H. (2000). The public release of performance data: what do we expect to gain? A review of the evidence. Journal of the American Medical Association 283 (14), 1866-1874.

. Schneider, E.C. and Epstein, A.M. (1998). Use of public performance reports: a survey of patients undergoing cardiac surgery. Journal of the American Medical Association 279 (20), 1638-1642.

. Anell, A., Rosen, P. and Hjortsberg, C. (1997). Choice and participation in the health services: a survey of preferences among Swedish residents. Health Policy 40 (2), 157-168.




DOI: http://dx.doi.org/10.5750/ijpcm.v1i2.79

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