Kriterien für die Priorisierung medizinischer Leistungen im Licht eines regionalen Surveys – Ergebnisse und methodologische Fragen
Kriterien für die Priorisierung medizinischer Leistungen im Licht eines regionalen Surveys – Ergebnisse und methodologische Fragen
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根据区域调查确定医疗服务优先顺序的标准 - 结果和方法问题
DOI：
10.1055/s-0033-1347267
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发表时间：
2014
期刊：
影响因子：
1.1
通讯作者：
Hecker
中科院分区：
文献类型：
--
作者：
Stumpf;Hecker
目的在德国，与许多其他国家相反，科学家和医学专业人士几乎在没有咨询德国公民的情况下讨论了医学的优先顺序。我们讨论了什么样的问卷调查可以有助于了解公民对优先顺序的态度的问题，重点是该方法的一些困难和挑战。方法我们对吕贝克市的3000名居民进行了随机抽样的邮政调查（年龄≥ 18）。受访者被要求评估不同的实质性和程序性标准，优先在医学。除了描述性的统计分析，逻辑回归模型进行，以确定潜在的解释变量的评估优先criteris.ResultsThe响应率为45.6%（N= 1 363）。一些优先标准被大多数人接受：疾病的严重程度，干预措施的有效性和坚实的证据基础。其他标准也受到了争议：个人生活方式，对家庭成员的责任和对儿童的普遍优先考虑。患者在社会和年龄中的责任以及干预的成本效益比通常被拒绝。Logistic回归分析的结果显示，人口统计学和健康相关变量的一些显着，但较小的影响。我们研究中的公民希望医疗保健的决策程序是透明的，并平等地适用于所有患者。根据调查受访者的决定有关的服务目录的德国的法定健康保险应主要由医生。法定的健康保险以及患者和科学家也应该参加决策程序。DiscussionComparing我们的结果，一个国家的访谈调查揭示了一些相关的差异：受访者的一些实质性的标准的评估似乎有所不同，根据上下文和措辞的项目。我们发现参与者对医疗保健潜在决策者的评价差异较小，但仍有一些不一致的结果。令我们惊讶的是，逻辑回归模型，包括标准的人口统计和健康相关的变量只占一小部分的方差的所有因变量。ConclusionOur讨论强调了一些困难和挑战的问卷调查的优先标准，反映了德国辩论的优先地位。在我们2009年秋季的调查之前，几乎没有关于这个问题的任何公开讨论。因此，人们不太可能能够说出知情的偏好。相反，他们似乎遵循了某种”社会反射”，这取决于每个项目的上下文和措辞。今后关于优先选择和优先事项的研究应（一）事先更密切地评估对每个项目的理解，（二）使研究的目的和方法适应有关专题的公共讨论的实际阶段。
AimsIn Germany, in contrast to many foreign countries, scientists and medical professionals have been discussing prioritisation in medicine almost without consulting German citizens. We address the question of what questionnaire surveys can contribute to the understanding of citizens' attitudes towards prioritisation-with a focus on some difficulties and challenges of the method.MethodWe conducted a postal survey with a random sample of 3 000 residents of the City of Lübeck (age≥ 18). Respondents were asked to appraise different substantial and procedural criteria for prioritisation in medicine. In addition to descriptive statistical analyses, logistical regression models were performed to identify potential explanatory variables for the appraisal of prioritisation criteria.ResultsThe response rate was 45.6%(N= 1 363). Some prioritisation criteria are accepted by the majority: severity of disease, effectiveness of an intervention and a firm evidence base. Other criteria were appraised controversially: personal life-style, responsibility for family members and general prioritisation of children. A patient's responsibility in society and age as well as an intervention's cost-benefit ratio were generally rejected. The results of logistic regression analyses showed some significant but minor effects of demographic and health-related variables. The citizens in our study want decision-making procedures in health care to be transparent and equally applied to all patients. According to the survey respondents decisions about the catalogue of services of Germany's statutory health insurance should mainly be made by doctors. The statutory health insurance as well as patients and scientists also should take part in the decision-making procedure.DiscussionComparing our results to those of a national interview survey reveals some relevant differences: The respondents' assessment of some substantial criteria seems to vary according to the contextualisation and wording of the items. We found less difference-but still some inconsistent results-in the participants' appraisal of potential decision-makers in health care. To our surprise, the logistic regression models including standard demographic and health-related variables account for only a small proportion of the variance of all dependent variables.ConclusionOur discussion emphasises some difficulties and challenges of questionnaire surveys on prioritisation criteria-reflecting on the state of the German debate on prioritisation. There has been hardly any public discussion on this issue prior to our survey in autumn 2009. It is thus unlikely that people have been able to state well-informed preferences. Instead they seem to have followed some kind of" social reflexes" depending on the context and wording of each item. Subsequent studies on preferences and priorities should (i) more closely assess the understanding of each item in advance and (ii) adapt the aims of their study and its methodology to the actual stage of the public discourse on the topic in question.