Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany.
Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany.
Int J Environ Res Public Health. 2022 Jun 17;19(12):7426. doi: 10.3390/ijerph19127426.
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.
德国于 2018 年 12 月引入了新的第二诊疗意见指令（SOD），用于子宫切除术、扁桃体切除术和扁桃体切除术，以支持共同决策并避免不必要的手术。由于该指令最近才实施，因此缺乏关于其结果和所遇到挑战的证据和见解，特别是来自医生的角度。为了评估这一点，我们采用了探索性顺序混合方法设计，首先进行定性分析，然后进行定量评估。对 22 名妇科和耳鼻喉科专家的访谈进行了定性分析，随后对这两个学科的 136 名医生进行了调查的统计分析。专家们对新的 SOD 总体持积极态度，强调了以患者为中心、决策支持和患者安全等方面。然而，他们也强调了 SOD 实施方面的以下结构问题：除了组织工作量增加之外，专家们还批评了 SOD 在农村地区的实施情况，因为那里的转诊专家资源匮乏。目前指令的实施存在障碍，例如授权第二诊疗意见医生的资格要求的调整，以及相关适应症的纳入，需要重点考虑，以更好地与日常实践保持一致。
