title: Long-term satisfaction after neurological second opinions and tertiary referrals.
abstract: OBJECTIVE
  The number of second opinions (SO) and tertiary referrals (TR) in neurology is increasing. Previously, we showed that a day-care admission for neurological SO's and TR's often results in a new diagnosis and/or treatment advice and increases patient satisfaction. However, long-term satisfaction for these consultations has never been studied. The main purpose of this study was to investigate long-term satisfaction in these groups of patients.
  
  
  METHODS
  A 2-year follow-up study in 300 patients who had attended a day-care clinic for SO and TR. Long-term satisfaction was assessed with a questionnaire using four Visual Analogue Scale (VAS) satisfaction items (ranging 0-10). Patients were asked if they had sought further consultations for the same problem after they had consulted the day-care clinic. A model was constructed to assess predictors for seeking new consultations.
  
  
  RESULTS
  Overall satisfaction decreased 2.4 (SD 2.4) points during follow-up to the same level as before the consultation. The decrease was similar in SO and TR patients. Twenty-eight per cent of the patients consulted other health-care workers. Greater satisfaction immediately after the consultation was the only predictor for not seeking additional consultations (OR 0.78, 95% CI 0.61-0.99 for every point increase on VAS).
  
  
  CONCLUSIONS
  Despite a high rate of new diagnoses and advised treatments, long-term satisfaction decreased after 2 years to baseline levels. These results question the long-term efficacy of a day-care clinic to evaluate neurological second opinions and tertiary referrals.
authors: Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. l.wieske@amc.uva.nl
authors: L
authors: L
authors: Wieske
authors: E
authors: E
authors: Richard
authors: D
authors: D
authors: Wijers
authors: J
authors: J
authors: Stam
authors: E M A
authors: EM
authors: Smets
authors: M D I
authors: MD
authors: Vergouwen
mesh_terms: D000328:Adult; D000368:Aged; D003951:Diagnostic Errors / Q000517:prevention & control / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D009426:Netherlands / Q000453:epidemiology; D017060:Patient Satisfaction; D012017:Referral and Consultation; D013995:Time