Previously submitted to: Journal of Participatory Medicine (no longer under consideration since Jul 16, 2019)
Date Submitted: Apr 25, 2019
Open Peer Review Period: Apr 30, 2019 - Jun 25, 2019
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Patient and Provider Perspectives Regarding Criteria for Patient Prioritization in Rehabilitation Programs
Queueing patients on waiting lists is a common practice to manage access to rehabilitation services. To increase fairness and equity in access, a strategy emerging from the literature is patient prioritization. The goal is for patients with the greatest needs to be treated first and for patient wait times to be determined objectively on the basis of explicit criteria. Selecting criteria, however, is a complex task because it is important to simultaneously consider the objectives of all stakeholders.
The aim of this study was to compare service users’ and service providers’ perspectives regarding patient prioritization criteria in two rehabilitation programs.
We conducted a multiple case study in two rehabilitation programs at the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec City (Canada), i.e. a driving evaluation program (DEP) and a compression garment manufacturing program (CGMP). We sent a web-based survey asking two groups (patients and providers) of informed stakeholders to individually produce a set of criteria. We then conducted an inductive thematic analysis where each group’s individual answers were coded and combined in a single set of criteria.
Stakeholders from the DEP identified a total of 22 criteria to prioritize patients while those from the CGMP listed 27 criteria. Providers shared 76% of the criteria mentioned by patients. Some criteria, such as age, occupation, functional level, pain, absence of caregiver, and time since referral, were considered important by both stakeholders in both programs.
Patients and providers tended to have similar opinions about a majority of the criteria to prioritize patients in waitlists. Nonetheless, our study confirms that patients and providers base their choices on different types of knowledge and values, which explains some of the differences observed. Taking into consideration the opinions of all stakeholders concerning prioritization criteria is an important part of the decision-making process, based on a multiple constituency approach.
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