Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals.
Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals.
复制标题
对成本效益和公平的态度：一项检验医疗专业人员观点的横断面研究。
DOI：
10.1136/bmjopen-2017-017251
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发表时间：
2017
期刊：
影响因子：
2.9
通讯作者：
Salem,Deeb
中科院分区：
文献类型：
--
作者：
Li,DavidG;Wong,GordonX;Martin,DavidT;Tybor,DavidJ;Kim,Jennifer;Lasker,Jeffrey;Mitty,Roger;Salem,Deeb
ObjectiveTo determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making.DesignIn this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population.SettingThree Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre.Participants819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories.Main outcome(s) and measure(s)Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity.ResultsA total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001).ConclusionsCost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.
