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

A. Victoor, J. Noordman, J.A. Sonderkamp, D. Delnoij, R.D. Friele, S. van Dulmen, J.J.D.J.M. Rademakers

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Abstract

Background
Today, 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.
Methods
In 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.
Results
The 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.
Conclusions
We 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.
Keywords: Choice behaviour, Patient freedom of choice laws, Healthcare providers, Healthcare reform, Communication, General practitioners, Referral, Physicians’ role
Original languageEnglish
Article number189
JournalBMC Family Practice
Volume14
DOIs
Publication statusPublished - 2013

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@article{bd3b19296e8a46c8b0b21f62ee335150,
title = "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",
abstract = "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.Keywords: Choice behaviour, Patient freedom of choice laws, Healthcare providers, Healthcare reform, Communication, General practitioners, Referral, Physicians’ role",
author = "A. Victoor and J. Noordman and J.A. Sonderkamp and D. Delnoij and R.D. Friele and {van Dulmen}, S. and J.J.D.J.M. Rademakers",
year = "2013",
doi = "10.1186/1471-2296-14-189",
language = "English",
volume = "14",
journal = "BMC Family Practice",
issn = "1471-2296",
publisher = "BioMed Central",

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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. / Victoor, A.; Noordman, J.; Sonderkamp, J.A.; Delnoij, D.; Friele, R.D.; van Dulmen, S.; Rademakers, J.J.D.J.M.

In: BMC Family Practice, Vol. 14, 189, 2013.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Are patients' preferences regarding the place of treatment heard and addressed at the point of referral

T2 - An exploratory study based on observations of GP-patient consultations

AU - Victoor, A.

AU - Noordman, J.

AU - Sonderkamp, J.A.

AU - Delnoij, D.

AU - Friele, R.D.

AU - van Dulmen, S.

AU - Rademakers, J.J.D.J.M.

PY - 2013

Y1 - 2013

N2 - 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.Keywords: Choice behaviour, Patient freedom of choice laws, Healthcare providers, Healthcare reform, Communication, General practitioners, Referral, Physicians’ role

AB - 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.Keywords: Choice behaviour, Patient freedom of choice laws, Healthcare providers, Healthcare reform, Communication, General practitioners, Referral, Physicians’ role

U2 - 10.1186/1471-2296-14-189

DO - 10.1186/1471-2296-14-189

M3 - Article

VL - 14

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

M1 - 189

ER -