Physicians’ Perspectives on the Implementation of the Second Opinion Directive in Germany—An Exploratory Sequential Mixed-Methods Study

Susann May, Dunja Bruch, Felix Muehlensiepen, Yuriy Ignatyev, Edmund Neugebauer, Cecile Ronckers and Sebastian von Peter
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Susann May: Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany
Dunja Bruch: Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany
Felix Muehlensiepen: Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany
Yuriy Ignatyev: Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany
Edmund Neugebauer: Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany
Cecile Ronckers: Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany
Sebastian von Peter: Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany

IJERPH, 2022, vol. 19, issue 12, 1-19

Abstract: A new Second Opinion Directive (SOD) was introduced in Germany in December 2018 for hysterectomy, tonsillotomy, and tonsillectomy to support shared decision making and to avoid unnecessary surgeries. Owing to its recent implementation, evidence and insights regarding outcomes and challenges encountered with the SOD are lacking, notably from the physicians’ perspective. To assess this, we undertook an exploratory sequential mixed-methods design with an initial qualitative phase followed by a quantitative evaluation. A qualitative analysis of 22 interviews with specialists in gynecology and otorhinolaryngology was followed by a statistical analysis of a survey of 136 physicians in those disciplines. The specialists expressed a generally positive opinion of the new SOD, emphasizing the aspects of patient orientation, support in decision making, and patient safety. However, they also highlighted the following structural problems regarding the SOD implementation: In addition to an increased organisational effort, the specialists criticised the SOD with regard to its implementation in rural regions with a low availability of specialists for referral. Barriers that impede the implementation of the current directive, such as the adaptation of the qualifying requirements for authorized second opinion physicians, as well as the inclusion of relevant indications, need focused consideration to obtain better alignment with everyday practice.

Keywords: second opinion; surgery; patient safety; mixed-methods; informed decision making; health system (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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