Guidelines and clinical priority setting during the COVID-19 pandemic - Norwegian doctors' experiences.

Autor: Bringedal BH; Institute for Studies of the Medical Profession, Oslo, Norway. berit.bringedal@lefo.no., Rø KI; Institute for Studies of the Medical Profession, Oslo, Norway., Bååthe F; Institute for Studies of the Medical Profession, Oslo, Norway.; Institute of Stress Medicine - ISM at Region VGR, Gothenburg, Sweden.; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden., Miljeteig I; Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Research and Development, Helse Bergen Health Trust, Bergen, Norway., Magelssen M; Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.; MF Norwegian School of Theology, Religion and Society, Oslo, Norway.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2022 Sep 22; Vol. 22 (1), pp. 1192. Date of Electronic Publication: 2022 Sep 22.
DOI: 10.1186/s12913-022-08582-2
Abstrakt: Background: In the first phase of the COVID-19 pandemic, strong measures were taken to avoid anticipated pressure on health care, and this involved new priorities between patient groups and changing working conditions for clinical personnel. We studied how doctors experienced this situation. Our focus was their knowledge about and adherence to general and COVID-19 specific guidelines and regulations on priority setting, and whether actual priorities were considered acceptable.
Methods: In December 2020, 2 316 members of a representative panel of doctors practicing in Norway received a questionnaire. The questions were designed to consider a set of hypotheses about priority setting and guidelines. The focus was on the period between March and December 2020. Responses were analyzed with descriptive statistics and regression analyses.
Results: In total, 1 617 (70%) responded. A majority were familiar with the priority criteria, though not the legislation on priority setting. A majority had not used guidelines for priority setting in the first period of the pandemic. 60.5% reported that some of their patients were deprioritized for treatment. Of these, 47.5% considered it medically indefensible to some/a large extent. Although general practitioners (GPs) and hospital doctors experienced deprioritizations equally often, more GPs considered it medically indefensible. More doctors in managerial positions were familiar with the guidelines.
Conclusions: Most doctors did not use priority guidelines in this period. They experienced, however, that some of their patients were deprioritized, which was considered medically indefensible by many. This might be explained by a negative reaction to the externally imposed requirements for rationing, while observing that vulnerable patients were deprioritized. Another interpretation is that they judged the rationing to have gone too far, or that they found it hard to accept rationing of care in general. Priority guidelines can be useful measures for securing fair and reasonable priorities. However, if the priority setting in clinical practice is to proceed in accordance with priority-setting principles and guidelines, the guidelines must be translated into a clinically relevant context and doctors' familiarity with them must improve.
(© 2022. The Author(s).)
Databáze: MEDLINE
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