Protocol for evaluating and implementing a pragmatic value-based healthcare management model for patients with inflammatory arthritis: a Danish population-based regional cohort and qualitative implementation study.

INTRODUCTION: The provision of healthcare for patients with inflammatory arthritis occurs in the context of somewhat conflicting targets, values and drivers. Therefore, there is a need for introducing 'value-based healthcare' defined as the value of patient relevant health outcomes in relation to costs. This term is a central part of tomorrow's healthcare sector, especially for rheumatic diseases, yet the transition is a huge challenge, as it will impact the development, delivery and assessment of healthcare. AIMS: The aim of this study is to compare medical and patient evaluated impact of the traditional settlement and financing production (DAGS) controlled healthcare setting with a value-based and patient-centred adjunctive to standard care. METHODS AND ANALYSIS: Patients with inflammatory arthritis receiving treatment in routine care at the outpatient clinics in the Capital Region of Denmark will prospectively and consecutively be enrolled in a Non-Intervention-Study framework providing a pragmatic value-based management model. A Danish reference cohort, used for comparison will be collected as part of routine clinical care. The enrolment period will be from 1 June 2018 until 31December 2023. Baseline and follow-up visits will be according to routine clinical care. Registry data will be obtained directly from patients and include personal, clinical and outcomes information. The study results will be reported in accordance with the STROBE statement. ETHICS AND DISSEMINATION: The study has been notified to the Danish Data Protection Agency and granted authorisation for the period June 2018 to January 2025 (pending). Informed consent will be obtained from all patients before enrolment in the study. The study is approved by the ethics committee, Capital Region of Denmark (H-18013158). Results of the study will be disseminated through publication in international peer-reviewed journals.

Patients and general practitioners have different approaches to e-mail consultations.

INTRODUCTION: The few extant Danish studies on e-mail consultations were undertaken before it became manda-tory under Danish law to offer patients this form of consultation. This study investigates the ways in which patients and general practitioners communicate with each other by e-mail, explores factors influencing this means of communication and puts into perspective the potential of e-mail consultations in patient treatment. MATERIAL AND METHODS: The study is explorative and based on an individual interview and four qualitative focus group interviews. The empirical data were analysed from a social constructivist and a practice-theoretical approach. RESULTS: The study indicated that patients wanted to be able to use the general practitioner (GP) as a sparring partner in e-mail consultations. They expected a reply in case of uncertainties. The GPs found it difficult to handle complicated medical problems by e-mail and they tended to send a standard reply. A number of patients perceived the wording of the standard reply as a rejection of their problem. Patients highlighted the logistical advantages of e-mail consultations, the physical separation of doctor and patient which made it easier for them to disclose psychological or intimate issues. The GPs preferred short uncomplicated questions with no option for the patient to enter into a discussion. CONCLUSION: Patients and GPs have different approaches to e-mail. The development of clear guidelines for patients and revised guidelines for GPs regarding e-mail consultations is therefore recommended. FUNDING: not relevant. TRIAL REGISTRATION: journal no. 2012-41-0063 with the Danish Data Protection Agency.