BackgroundPhysician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians’ professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers’ evaluation of physicians’ performance.ObjectiveTo identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects.MethodsIn a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti’s method.ResultsIn the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes of care were also judged to be very important, but both parties agreed that they would not be evaluable by health care consumers.ConclusionsHealth care consumers in Switzerland show a high appraisal of the importance of physician-approved criteria for assessing health care performance and a moderate self-perception of how capable they are of assessing the quality and performance of a physician. This study supports that health care consumers are differentiating between aspects they perceive they would be able to evaluate after a visit to a physician (such as attributes of structure and the interpersonal skills of a doctor), and others that lay beyond their ability to make an accurate judgment about (such as technical skills of a physician and outcome of care).
BackgroundWeb users are increasingly encouraged to rate and review consumer services (eg, hotels, restaurants) and, more recently, this is also the case for physicians and medical services. The resemblance in the setup and design of commercial rating websites (CRWs) and Web-based physician rating websites (PRWs) raises the question of whether choice-making processes based on the two types of websites could also be similar.ObjectiveThis qualitative study sought to explore the extent to which consumer decision making based on Web-based reviews is the same for consumer services (ie, choice of a hotel) and health services (ie, choice of a pediatrician), while providing an in-depth understanding of potential differences or similarities.MethodsBetween June and August 2015, we carried out a total of 22 qualitative interviews with young parents residing in the German-speaking part of Switzerland. Participants were invited to complete 2 choice tasks, which involved (1) choosing a hotel based on the commercial Web-based rating website TripAdvisor and (2) selecting a pediatrician based on the PRW Jameda. To better understand consumers’ thought processes, we instructed participants to “think aloud”, namely to verbalize their thinking while sorting through information and reaching decisions. Using a semistructured interview guide, we subsequently posed open-ended questions to allow them to elaborate more on factors influencing their decision making, level of confidence in their final choice, and perceived differences and similarities in their search for a hotel and a physician. All interviews were recorded, transcribed, and analyzed using an inductive thematic approach.ResultsParticipants spent on average 9:57 minutes (standard deviation=9:22, minimum=3:46, maximum=22:25) searching for a hotel and 6:17 minutes (standard deviation=4:47, minimum=00:38, maximum=19:25) searching for a pediatrician. Although the choice of a pediatrician was perceived as more important than the choice of a hotel, participants found choosing a physician much easier than selecting an appropriate accommodation. Four main themes emerged from the analysis of our interview data that can explain the differences in search time and choice confidence: (1) trial and error, (2) trust, (3) competence assessment, and (4) affect and likeability.ConclusionsOur results suggest that, despite congruent website designs, individuals only trust review information to choose a hotel, but refuse to fully rely on it for selecting a physician. The design and content of Web-based PRWs need to be adjusted to better address the differing information needs of health consumers.
BackgroundResearch has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly’s willingness to engage in treatment decisions.MethodsA self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65–80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants’ preference to be active, collaborative or passive in decision-making.ResultsMost of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults’ preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator.ConclusionsAs older adults’ health literacy plays a role in individuals’ willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients’ involvement in healthcare.
BackgroundWebsites on which users can rate their physician are becoming increasingly popular, but little is known about the website quality, the information content, and the tools they offer users to assess physicians. This study assesses these aspects on physician-rating websites in German- and English-speaking countries.ObjectiveThe objective of this study was to collect information on websites with a physician rating or review tool in 12 countries in terms of metadata, website quality (transparency, privacy and freedom of speech of physicians and patients, check mechanisms for appropriateness and accuracy of reviews, and ease of page navigation), professional information about the physician, rating scales and tools, as well as traffic rank.MethodsA systematic Web search based on a set of predefined keywords was conducted on Google, Bing, and Yahoo in August 2016. A final sample of 143 physician-rating websites was analyzed and coded for metadata, quality, information content, and the physician-rating tools.ResultsThe majority of websites were registered in the United States (40/143) or Germany (25/143). The vast majority were commercially owned (120/143, 83.9%), and 69.9% (100/143) displayed some form of physician advertisement. Overall, information content (mean 9.95/25) as well as quality were low (mean 18.67/47). Websites registered in the United Kingdom obtained the highest quality scores (mean 26.50/47), followed by Australian websites (mean 21.50/47). In terms of rating tools, physician-rating websites were most frequently asking users to score overall performance, punctuality, or wait time in practice.ConclusionsThis study evidences that websites that provide physician rating should improve and communicate their quality standards, especially in terms of physician and user protection, as well as transparency. In addition, given that quality standards on physician-rating websites are low overall, the development of transparent guidelines is required. Furthermore, attention should be paid to the financial goals that the majority of physician-rating websites, especially the ones that are commercially owned, pursue.
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