Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion

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.

Outcomes of a medical second opinion programme before knee arthroplasty: A prospective cohort study

“…The 40% agreement rate between the IP and SP for a current indication for KA was higher than that from another evaluation of an SO in Germany that found only 26% agreement between the IP and SP for the recommendation of knee surgery. In contrast to the present study, in the previous study, patients were not seen personally by the SP (31,32), and speci c results for KA were not presented. In the national SO programme "Best Doctors, Inc" in the United States, 34.6% of orthopaedic surgery patients changed their treatment after the SP recommendation (33).…”

“…The high satisfaction of the patients with 97% of patients rating the SO concept "very good" or "good" is in line with the results from second opinion portals who report 89% to 95% of satis ed patients (31)(32)(33).…”

“…The frequency of patients (85%) who reported a strong or very strong in uence of the SO on the treatment decision in this study was even higher than the 60% and 61% of patients reported in the literature (32,33). The face-to-face contact with the SP may have contributed to the high in uence of the SO on the treatment preference.…”

“…Second, the patients were not followed further. Thus, in this study, we could not con rm that patients nally followed their intended decision, but other studies suggest that the majority of patients adhere to their decision after the SO (32). Third, the SP did know the recommendations for KA made by the IP.…”

Second Opinions before Surgery Have the Potential to Reduce Costs – An Exploratory Analysis

“…B. eine dauerhafte oder temporäre Arbeitsunfähigkeit des Patienten und mögliche Rehabilitationsmaßnahmen infolge des Eingriffes. Gerade in Anbetracht der Komplexität vieler Indikationen bietet eine Zweitmeinung (nachfolgend als ZM abgekürzt) Patienten eine Unterstützung in ihrer Entscheidungsfindung, da es mitunter zu Diskrepanzen in der Indikationsstellung durch unterschiedliche Ärzte kommen kann [4]. Die Möglichkeit für Patienten, sich eine solche einzuholen, ist durch die gesetzliche Krankenversicherung (GKV) durchaus gegeben.…”