Study Finds Consumers Need Education Regarding Evidence-based Care

Many Consumers Confused by Terminology, Distrustful of Process

July 21, 2010 03:15 pm Sheri Porter

A study in the July issue of Health Affairs indicates that many consumers may be skeptical about the benefits of health care that uses an evidence-based approach -- which is the approach that forms part of the basis of recent efforts to reform the U.S. health care system overall.

The study, "Evidence That Consumers Are Skeptical About Evidence-Based Health Care(content.healthaffairs.org)," indicates that few consumers understand terms such as "medical evidence" and "clinical guidelines." According to the study, participants described such guidelines as representing a "minimum standard of care."

"Consumers' current knowledge, beliefs, attitudes and experiences related to health care are often incompatible with evidence-based approaches," wrote the authors of the study. Study participants believed that "any new treatment is improved treatment," and only 47 percent of survey respondents said it was reasonable to pay less out-of-pocket for the most effective treatments and drugs.

"Linking cost sharing to clinical effectiveness may be perceived as restricting treatment options, particularly for unproven therapies," wrote the authors.

Many respondents also equated high-quality care with higher-cost care. One-third of survey respondents agreed or strongly agreed with the statement "medical treatments that work the best usually cost more than treatments that don't work as well." Another 27 percent disagreed or strongly disagreed with that statement, and 40 percent said they were unsure.

"The consistent finding that consumers prefer subjective information from friends and family about selecting doctors and hospitals to objective information about performance and outcomes shows how difficult it is to shift toward an evidence-based approach to making health care choices," said the authors.

The researchers concluded that such "gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making."

"Clearly, consumers will revolt if evidence-based efforts are perceived as rationing or as a way to deny them needed treatment," said the authors. "Policymakers, employers, health plans, providers and researchers will thus need to translate evidence-based health care into accessible concepts and concrete activities that support and motivate consumers."

Study Employed Multiple Methods

According to the researchers, the study's purpose was to "determine how the concept of making health care decisions based on evidence of effectiveness could be translated into language that consumers would understand and embrace."

The researchers used a variety of qualitative research methods, including focus groups, in-depth interviews with stakeholders, cognitive interviews with employees and online surveys directed at consumers.

Focus groups and interviews were conducted in 2006 and 2007, and all were audiotaped. Researchers included people ages 18-64 who had health insurance through an employer and who had taken part in making decisions about coverage for themselves or others.

In addition, an online survey commissioned by the National Business Group on Health surveyed 1,500 people who had company-based health insurance.

According to the study authors, the study's most notable limitation is that, based on selection criteria, the study overrepresents people who were employed by large firms, who held health insurance and who identified themselves as responsible for health care decision-making.

The researchers noted that the study population was biased toward a "best case" scenario and concluded that their findings "may reflect a more optimistic assessment of consumer engagement than would be found in the broader U.S. population."

Researcher Responds to Study Results

Jill Mathews Yegian, director of research and evaluation at the California HealthCare Foundation in Oakland, is one of the seven study authors. She told AAFP News Now that there is a general lack of understanding among consumers about evidence-based medicine and the fact that such evidence evolves slowly over time.

She pointed to new U.S. Preventive Services Task Force guidelines on breast cancer screening(www.uspreventiveservicestaskforce.org), which caused a public uproar(jama.jamanetwork.com) late in 2009, as an example of the general population's lack of knowledge on the issue.

"I'm not sure that we've done a great job of conveying that there are risks associated with all treatments and with many diagnosis processes as well," said Yegian. Consequently, consumers "interpret that any advice that is against getting more care must be driven by (someone else's) concerns about cost."

"We know from the research that leading (this discussion) with cost is a nonstarter," said Yegian.

She ventured this hypothesis: If the health care industry can move away from the delivery of marginal and less effective health care and embrace evidence-based diagnostic procedures and treatments, then health care costs would come down. But before that can happen, consumers must have confidence that they are receiving the right care at the right time and in the right setting.

Yegian also noted, "These issues have been with us for a long time, and they won't be resolved overnight. This is a marathon; it's not a sprint."

What happens if consumers' minds can't be changed?

"My sense is that if consumers really dig in their heels, then we will miss a great opportunity," said Yegian. The country likely will see a "continuing erosion of the value of what we get for the (health care) dollars we're paying," she added.


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