UK vs US physician decision-making in the treatment of haemophilia.

INTRODUCTION: Patient-physician shared decision-making (SDM) has become increasingly seen as having a positive effect on management of chronic diseases. However, little is known of the factors that encourage SDM or how effective it may be at improving health outcomes or how cost-effective it is.

AIM: To investigate the uses and applications of patient physician-SDM in the management of haemophilia and the influence of healthcare systems in the United States and the United Kingdom.

METHODS: This was a qualitative study based on interviews with treatment experts in the United States and United Kingdom. A grounded theory approach was used to analyse the data from the transcribed interviews and themes that emerged as related to the decision influencers. Twelve physicians from each country were interviewed by the author.

RESULTS: Treatment guidelines were viewed as having only limited applicability because of the lack of universal best options in haemophilia. The US physicians in the sample appeared to be more influenced by patient preferences than physicians in the UK, who instead tended to follow policies and standards of care more closely. Physicians in both countries commented that many of their patents had become highly knowledgeable of their bleeding disorder. US physicians were sometimes limited by insurance company policies but also reported that they were often successful in appealing insurance decisions.

CONCLUSION: The research suggests that there are different influences on decision-making between healthcare systems; patients and overarching healthcare systems play a major role in how physicians treat haemophilia.