Clinicians’ reported use of clinical priority assessment criteria and their attitudes to prioritization for elective surgery: a cross-sectional survey

Authors

  • Deborah McLeod,

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • Sonya Morgan,

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • Eileen McKinlay,

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • Kevin Dew,

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • Jackie Cumming,

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • Anthony Dowell,

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • Tom Love

    1. Departments of *General Practice and †Public Health, Wellington School of Medicine and Health Sciences; and ‡Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
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  • D. McLeod DPH, PhD; S. Morgan BSc; E. McKinlay RCpN, MA (App); K. Dew BA(hons), PhD; J. Cumming Dip Health Economics, PhD; A. Dowell FRCGP; T. Love MPH, BA.

Dr D. McLeod, Department of General Practice, PO Box 7343, Wellington School of Medicine and Health Sciences, Wellington South, New Zealand.
Email: dmcleod@wnmeds.ac.nz

Abstract

Objectives:  To explore the attitudes of clinicians working in New Zealand publicly funded hospitals towards prioritizing patients for elective surgery, and their reported use of clinical priority assessment criteria (CPAC).

Design:  A cross-sectional study using a postal questionnaire. The questionnaire drew on themes identified from an earlier qualitative study. Questions were closed and information was sought about perceptions of the need to prioritize patients, effective ways of doing so and the use of CPAC.

Setting:  New Zealand

Participants:  A national sample of cardiologists, cardiac, general and orthopaedic surgeons, and registrars.

Results:  Three hundred and thirty-two clinicians responded to the survey (74.1%). Respondents generally agreed that a nationally consistent method of prioritizing patients for surgery was required but felt their clinical judgement was the most effective way of prioritizing patients. Current CPAC were considered to be administrative tools and there was marked variation in their reported use. Consistent use of CPAC using the constructs provided was more likely to be reported by cardiac specialists than general or orthopaedic surgeons. Other features of the hospital system in which surgeons worked also had a major impact on access to elective surgery.

Conclusions:  Clinicians recognized the need for a nationally consistent method of prioritizing patients. Although most did not consider current CPAC were effective in achieving this, many felt there was some potential in further development of tools. However, further development is problematic in the absence of objective measures of need and ability to benefit.

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