Long-term satisfaction after neurological second opinions and tertiary referrals

Eur J Neurol. 2011 Nov;18(11):1310-6. doi: 10.1111/j.1468-1331.2011.03394.x. Epub 2011 Mar 24.

Abstract

Background and purpose: The number of second opinions (SO) and tertiary referrals (TR) in neurology is increasing. Previously, we showed that a day-care admission for neurological SO's and TR's often results in a new diagnosis and/or treatment advice and increases patient satisfaction. However, long-term satisfaction for these consultations has never been studied. The main purpose of this study was to investigate long-term satisfaction in these groups of patients.

Methods: A 2-year follow-up study in 300 patients who had attended a day-care clinic for SO and TR. Long-term satisfaction was assessed with a questionnaire using four Visual Analogue Scale (VAS) satisfaction items (ranging 0-10). Patients were asked if they had sought further consultations for the same problem after they had consulted the day-care clinic. A model was constructed to assess predictors for seeking new consultations.

Results: Overall satisfaction decreased 2.4 (SD 2.4) points during follow-up to the same level as before the consultation. The decrease was similar in SO and TR patients. Twenty-eight per cent of the patients consulted other health-care workers. Greater satisfaction immediately after the consultation was the only predictor for not seeking additional consultations (OR 0.78, 95% CI 0.61-0.99 for every point increase on VAS).

Conclusion: Despite a high rate of new diagnoses and advised treatments, long-term satisfaction decreased after 2 years to baseline levels. These results question the long-term efficacy of a day-care clinic to evaluate neurological second opinions and tertiary referrals.

MeSH terms

  • Adult
  • Aged
  • Diagnostic Errors / prevention & control
  • Diagnostic Errors / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nervous System Diseases / diagnosis*
  • Nervous System Diseases / epidemiology
  • Nervous System Diseases / psychology*
  • Netherlands / epidemiology
  • Patient Satisfaction*
  • Referral and Consultation*
  • Time