Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration
Abstract Background In response to the development of highly effective but expensive new medications, policymakers, payors, and health systems are considering novel and pragmatic ways to provide these medications to patients. One approach is to target these treatments to those most likely to benefit...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-05-01
|
Series: | BMC Health Services Research |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12913-020-05211-8 |
id |
doaj-083255ae6db548ebac42aafc4cca8dc4 |
---|---|
record_format |
Article |
spelling |
doaj-083255ae6db548ebac42aafc4cca8dc42020-11-25T04:03:23ZengBMCBMC Health Services Research1472-69632020-05-0120111210.1186/s12913-020-05211-8Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health AdministrationAkbar K. Waljee0Kerry A. Ryan1Chris D. Krenz2George N. Ioannou3Lauren A. Beste4Monica A. Tincopa5Sameer D. Saini6Grace L. Su7Maria E. Arasim8Patti T. Roman9Brahmajee K. Nallamothu10Raymond De Vries11VA Ann Arbor Health Services Research and Development Center of Clinical Management ResearchCenter for Bioethics and Social Sciences in Medicine, University of Michigan Medical SchoolCenter for Bioethics and Social Sciences in Medicine, University of Michigan Medical SchoolVeterans Affairs Puget Sound Healthcare SystemDivision of Gastroenterology, Department of Medicine, University of WashingtonMichigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, 3912 Taubman CenterVA Ann Arbor Health Services Research and Development Center of Clinical Management ResearchVA Ann Arbor Health Services Research and Development Center of Clinical Management ResearchVA Ann Arbor Health Services Research and Development Center of Clinical Management ResearchVA Ann Arbor Health Services Research and Development Center of Clinical Management ResearchVA Ann Arbor Health Services Research and Development Center of Clinical Management ResearchCenter for Bioethics and Social Sciences in Medicine, University of Michigan Medical SchoolAbstract Background In response to the development of highly effective but expensive new medications, policymakers, payors, and health systems are considering novel and pragmatic ways to provide these medications to patients. One approach is to target these treatments to those most likely to benefit. However, to maximize the fairness of these policies, and the acceptance of their implementation, the values and beliefs of patients should be considered. The provision of treatments for chronic hepatitis C (CHC) in the resource-constrained context of the Veterans Health Administration (VHA) offered a real-world example of this situation, providing the opportunity to test the value of using Democratic Deliberation (DD) methods to solicit the informed opinions of laypeople on this complex issue. Methods We recruited Veterans (n = 30) from the VHA to attend a DD session. Following educational presentations from content experts, participants engaged in facilitated small group discussions to: 1) identify strategies to overcome CHC treatment barriers and 2) evaluate, vote on, and modify/improve two CHC treatment policies – “first come, first served” (FCFS) and “sickest first” (SF). We used transcripts and facilitators’ notes to identify key themes from the small group discussions. Additionally, participants completed pre- and post-DD surveys. Results Most participants endorsed the SF policy over the FCFS policy, emphasizing the ethical and medical appropriateness of treating the sickest first. Concerns about SF centered on the difficulty of implementation (e.g., how is “sickest” determined?) and unfairness to other Veterans. Proposed modifications focused on: 1) the need to consider additional health factors, 2) taking behavior and lifestyle into account, 3) offering education and support, 4) improving access, and 5) facilitating better decision-making. Conclusions DD offered a robust and useful method for addressing the allocation of the scarce resource of CHC treatment. Participants were able to develop a modified version of the SF policy and offered diverse recommendations to promote fairness and improve quality of care for Veterans. DD is an effective approach for incorporating patient preferences and gaining valuable insights for critical healthcare policy decisions in resource-limited environments.http://link.springer.com/article/10.1186/s12913-020-05211-8VeteransVAPublic deliberationDemocratic DeliberationHepatitis CQualitative research |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Akbar K. Waljee Kerry A. Ryan Chris D. Krenz George N. Ioannou Lauren A. Beste Monica A. Tincopa Sameer D. Saini Grace L. Su Maria E. Arasim Patti T. Roman Brahmajee K. Nallamothu Raymond De Vries |
spellingShingle |
Akbar K. Waljee Kerry A. Ryan Chris D. Krenz George N. Ioannou Lauren A. Beste Monica A. Tincopa Sameer D. Saini Grace L. Su Maria E. Arasim Patti T. Roman Brahmajee K. Nallamothu Raymond De Vries Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration BMC Health Services Research Veterans VA Public deliberation Democratic Deliberation Hepatitis C Qualitative research |
author_facet |
Akbar K. Waljee Kerry A. Ryan Chris D. Krenz George N. Ioannou Lauren A. Beste Monica A. Tincopa Sameer D. Saini Grace L. Su Maria E. Arasim Patti T. Roman Brahmajee K. Nallamothu Raymond De Vries |
author_sort |
Akbar K. Waljee |
title |
Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration |
title_short |
Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration |
title_full |
Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration |
title_fullStr |
Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration |
title_full_unstemmed |
Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration |
title_sort |
eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis c treatment in the veterans health administration |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2020-05-01 |
description |
Abstract Background In response to the development of highly effective but expensive new medications, policymakers, payors, and health systems are considering novel and pragmatic ways to provide these medications to patients. One approach is to target these treatments to those most likely to benefit. However, to maximize the fairness of these policies, and the acceptance of their implementation, the values and beliefs of patients should be considered. The provision of treatments for chronic hepatitis C (CHC) in the resource-constrained context of the Veterans Health Administration (VHA) offered a real-world example of this situation, providing the opportunity to test the value of using Democratic Deliberation (DD) methods to solicit the informed opinions of laypeople on this complex issue. Methods We recruited Veterans (n = 30) from the VHA to attend a DD session. Following educational presentations from content experts, participants engaged in facilitated small group discussions to: 1) identify strategies to overcome CHC treatment barriers and 2) evaluate, vote on, and modify/improve two CHC treatment policies – “first come, first served” (FCFS) and “sickest first” (SF). We used transcripts and facilitators’ notes to identify key themes from the small group discussions. Additionally, participants completed pre- and post-DD surveys. Results Most participants endorsed the SF policy over the FCFS policy, emphasizing the ethical and medical appropriateness of treating the sickest first. Concerns about SF centered on the difficulty of implementation (e.g., how is “sickest” determined?) and unfairness to other Veterans. Proposed modifications focused on: 1) the need to consider additional health factors, 2) taking behavior and lifestyle into account, 3) offering education and support, 4) improving access, and 5) facilitating better decision-making. Conclusions DD offered a robust and useful method for addressing the allocation of the scarce resource of CHC treatment. Participants were able to develop a modified version of the SF policy and offered diverse recommendations to promote fairness and improve quality of care for Veterans. DD is an effective approach for incorporating patient preferences and gaining valuable insights for critical healthcare policy decisions in resource-limited environments. |
topic |
Veterans VA Public deliberation Democratic Deliberation Hepatitis C Qualitative research |
url |
http://link.springer.com/article/10.1186/s12913-020-05211-8 |
work_keys_str_mv |
AT akbarkwaljee elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT kerryaryan elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT chrisdkrenz elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT georgenioannou elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT laurenabeste elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT monicaatincopa elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT sameerdsaini elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT gracelsu elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT mariaearasim elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT pattitroman elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT brahmajeeknallamothu elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration AT raymonddevries elicitingpatientviewsontheallocationoflimitedhealthcareresourcesadeliberationonhepatitisctreatmentintheveteranshealthadministration |
_version_ |
1724440405323284480 |