Physicians' Perspectives on the Implementation of the Second Opinion Directive in Germany-An Exploratory Sequential...

Area of Science:

• Health Services Research
• Medical Policy
• Surgical Outcomes

Background:

• A new Second Opinion Directive (SOD) was implemented in Germany in December 2018 for specific surgeries like hysterectomy and tonsillectomy.
• The directive aims to enhance shared decision-making and reduce unnecessary surgical procedures.
• Limited data exists on the outcomes and challenges of the SOD from a physician's viewpoint due to its recent implementation.

Purpose of the Study:

• To explore physicians' perspectives on the outcomes and challenges of the Second Opinion Directive (SOD).
• To gather insights into the practical implementation of the SOD in routine medical practice.

Main Methods:

• An exploratory sequential mixed-methods design was employed, starting with qualitative interviews and followed by quantitative surveys.
• Qualitative data was collected from 22 interviews with specialists in gynecology and otorhinolaryngology.
• Quantitative data was gathered through a statistical analysis of a survey administered to 136 physicians in these specialties.

Main Results:

• Physicians generally hold a positive view of the SOD, appreciating its patient-centered approach, decision-making support, and contribution to patient safety.
• Structural challenges were identified, including increased organizational workload and difficulties in implementation within rural areas with limited specialist availability.
• Barriers to effective implementation include the need to adapt qualification requirements for second opinion physicians and refine the inclusion of relevant surgical indications.

Conclusions:

• The Second Opinion Directive (SOD) shows promise in improving patient care and shared decision-making for specific surgeries.
• Addressing structural issues, such as specialist accessibility in rural regions and qualification criteria, is crucial for optimizing the SOD's alignment with clinical practice.
• Further refinement of the directive is necessary to overcome implementation barriers and maximize its benefits in everyday medical practice.