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Jolliffe L, Christie LJ, Fearn N, Nohrenberg M, Liu R, Williams JF, Parsons MW, Pearce AM. A systematic review of discrete choice experiments in stroke rehabilitation. Top Stroke Rehabil 2024:1-12. [PMID: 38372124 DOI: 10.1080/10749357.2024.2312641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions. MATERIAL AND METHODS A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality. RESULTS Of 2,446 studies screened, five were eligible. Studies focused on exercise preference (n = 3), the structure and delivery of community services (n = 1), and self-management programs (n = 1). All had small sample sizes (range 50-146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers). CONCLUSIONS Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation.
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Affiliation(s)
- Laura Jolliffe
- Department of Occupational Therapy, Peninsula Health, Melbourne, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Nicola Fearn
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
| | - Michael Nohrenberg
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Rasia Liu
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Julie F Williams
- Walter McGrath Library, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Mark W Parsons
- Department of Neurology, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- School of Medicine and Health, UNSW, Sydney, Australia
- Sydney Brain Centre, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Alison M Pearce
- School of Public Health, The University of Sydney, Camperdown, Australia
- The Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, The University of Sydney, Sydney, Australia
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Mutsekwa RN, Campbell KL, Canavan R, Mulhern B, Angus RL, Byrnes JM. Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment. THE PATIENT 2023; 16:165-177. [PMID: 36637751 DOI: 10.1007/s40271-022-00609-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Increased demand for gastroenterology services has resulted in growing waitlists, with patients at risk of exceeding clinically recommended wait-times. Given limited healthcare resources, expanded scope models of care are an option to help address this demand, but little is known about patient preferences for these models of care. METHODS Low-risk gastroenterology patients (n = 1198) referred to an outpatient tertiary service in Australia over a 2-year period were invited to participate in an unlabelled discrete choice experiment with seven attributes: primary healthcare professional, wait-time, continuity of care, consultation length, manner and communication skills, reassurance, and cost. These were developed using qualitative research, literature review, and stakeholders' experiences. A d-efficient fractional design was used to construct four blocks of 12 choice sets, with two alternatives. A 13th choice set was included as a data and quality check. Latent class and mixed logit regression were used for analysis. The resulting preference parameters for individual attributes were then used to calculate willingness to pay and willingness to wait. RESULTS Overall, the model based on the 347 respondents suggested no strong preference for professional background. All other attributes were statistically significant predictors of preference (p < 0.001), with respondents willing to make significant trade-offs (time and cost) before accepting deterioration in attributes. There was strong emphasis on manner and communication skills, with a clinician who listens and provides good explanations overwhelmingly the most important attribute. Latent class analysis identified two patient segments who differed in their preference for the primary treating healthcare professional (doctor or dietitian) based on exposure to either traditional medical or non-medical professional role substitution model. CONCLUSIONS Patients have strong but varied preferences for gastroenterology services based on whether they have been exposed to expanded scope models of care. Design and implementation of new models of care need to consider strategies to overcome any perceived loss in utility or deterioration in healthcare quality for those unfamiliar with professional role substitution.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia. .,Gold Coast Hospital and Health Service, Allied Health Research Team, Southport, QLD, Australia. .,Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport, Southport, QLD, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research, University of Technology Sydney, Sydney, NSW, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia.,School of Allied-health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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Preferences of Iranians to select the emergency department physician at the time of service delivery. BMC Health Serv Res 2021; 21:1155. [PMID: 34696787 PMCID: PMC8547076 DOI: 10.1186/s12913-021-07183-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023] Open
Abstract
Background Understanding patient preferences in emergency departments (EDs) can provide useful information to enhance patient-centred care and improve patient’s experience in hospitals. This study sought to find evidence about patients’ preference for physicians when receiving services in EDs in Iran. Methods In this discrete choice experiment survey, 811 respondents completed the scenarios with 5 attributes, including type of physicians, price of services, time to receive services, physician work experience, and physician responsibility. Analyses were conducted for different social and economic groups as well as for the total population. Results This study showed that the willingness to pay (WTP) for being visited by a physician with a high sense of responsibility was 67.104US$. WTP for being visited by an emergency medicine specialist (EMS) was 22.148US$. WTP for receiving ED services 1 min earlier was 0.417US$ and for being visited by 1 year higher experienced physician was 0.866US$. WTP varied across different age groups, sex, health status, education, and income groups. Conclusion As the expertise and experience of providers are important factors in selecting physicians in EDs by the patients, providing this information to patients when they want to select their providers can promote patient-centred care. This information can decrease patients’ uncertainty in the selection of their services and improve their experience in hospitals.
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Manuli A, Maggio MG, De Cola M, Tripoli D, De Luca R, Calabrò RS. Towards improving primary care: Considerations on a Sicilian population-based survey. J Family Med Prim Care 2019; 8:3647-3652. [PMID: 31803667 PMCID: PMC6881924 DOI: 10.4103/jfmpc.jfmpc_455_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/19/2019] [Accepted: 09/25/2019] [Indexed: 11/04/2022] Open
Abstract
Background The healthcare reforms have led to the development of new primary care systems. These models allowed responding to people's needs but with problems in maintaining the relational continuity between the patient and therapist. Materials and Methods We performed a survey on 12 May 2018, in Messina (Sicily, Italy), during an informational event. Participants were invited to fill in a self-reported Italian questionnaire composed of 12 multiple-choice questions, specifically created by the authors. The tool included the assessment of the social status, the presence of chronic diseases, preference in health care, and evaluation of the services offered in the territory. Results As for the territorial services, we observed that the general practitioner (GP) was the most appreciated healthcare provider, followed by the nurse. Conclusions We believe that nurses can represent the most appropriate healthcare figure to potentiate GP's patient management in primary territorial care.
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Abstract
OBJECTIVES It is desirable that public preferences are established and incorporated in emergency healthcare reforms. The aim of this study was to investigate preferences for local versus centralised provision of all emergency medical services (EMS) and explore what individuals think are important considerations for EMS delivery. DESIGN A discrete choice experiment was conducted. The attributes used in the choice scenarios were: travel time to the hospital, waiting time to be seen, length of stay in the hospital, risks of dying, readmission and opportunity for outpatient care after emergency treatment at a local hospital. SETTING North East England. PARTICIPANTS Participants were a randomly sampled general population, aged 16 years or above recruited from Healthwatch Northumberland network database of lay members and from clinical contact with Northumbria Healthcare National Health Service Foundation Trust via Patient Experience Team. PRIMARY AND SECONDARY OUTCOME MEASURES Analysis used logistic regression modelling techniques to determine the preference of each attribute. Marginal rates of substitution between attributes were estimated to understand the trade-offs individuals were willing to make. RESULTS Responses were obtained from 148 people (62 completed a web and 86 a postal version). Respondents preferred shorter travel time to hospital, shorter waiting time, fewer number of days in hospital, low risk of death, low risk of readmission and outpatient follow-up care in their local hospital. However, individuals were willing to trade off increased travel time and waiting time for high-quality centralised care. Individuals were willing to travel 9 min more for a 1-day reduction in length of stay in the hospital, 38 min for a 1% reduction in risk of death and 112 min for having outpatient follow-up care at their local hospital. CONCLUSIONS People value centralised EMS if it provides higher quality care and are willing to travel further and wait longer.
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Affiliation(s)
- Nawaraj Bhattarai
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Mcmeekin
- Faculty of Health and Life Sciences, University of Northumbria at Newcastle, Newcastle upon Tyne, UK
| | | | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Chudner I, Drach-Zahavy A, Karkabi K. Choosing Video Instead of In-Clinic Consultations in Primary Care in Israel: Discrete Choice Experiment Among Key Stakeholders-Patients, Primary Care Physicians, and Policy Makers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1187-1196. [PMID: 31563262 DOI: 10.1016/j.jval.2019.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Despite its innovative benefits, the adoption of video consultations (VCs) in primary care settings is complex and slow. OBJECTIVES To quantify the preferences of key stakeholders in Israel's primary care-patients, primary care practitioners, and policy makers-regarding VCs compared with traditional in-clinic consultations (ICC) in nonurgent conditions. METHODS Discrete choice experiment surveys were completed by 508 patients, 311 physicians, and 141 policy makers. These consisted of 12 choice tasks of 2 labeled alternatives (VC or ICC), with the 4 attributes most relevant to each stakeholder group. A random effects logit model analysis was used to estimate stakeholders' preferences. RESULTS All 4 experiments' attributes were significantly important in choosing VC versus ICC for the patient group and the physician group. Three out of 4 attributes were significantly important to policy makers. Differences and similarities between stakeholders were identified in attribute rank order, trade-offs, and VC uptake probabilities. Policy makers' VC uptake rate was 86%. Patients' preferences suggested that 68% of ICCs could be replaced by VCs. Physicians' VC uptake was 30% in cases in which the consultation purpose was to diagnose and provide treatment and 48% in cases in which the consultation purpose was follow-up. CONCLUSIONS Our findings show key stakeholders' preferences about VC integration, to be considered when these systems are introduced into primary care and optimize the implementation process. Although there is a stronger preference for ICC among physicians and patients, alternative combinations of attribute levels might be used to compensate and reconfigure a more preferred VC service.
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Affiliation(s)
- Irit Chudner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | | | - Khaled Karkabi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Family Medicine, Clalit Heath Services, Haifa, Israel
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Harris P, Whitty JA, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. The importance of population differences: Influence of individual characteristics on the Australian public's preferences for emergency care. Health Policy 2017; 122:115-125. [PMID: 29157994 DOI: 10.1016/j.healthpol.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/25/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022]
Abstract
A better understanding of the public's preferences and what factors influence them is required if they are to be used to drive decision-making in health. This is particularly the case for service areas undergoing continual reform such as emergency and primary care. Accordingly, this study sought to determine if attitudes, socio-demographic characteristics and healthcare experiences influence the public's intentions to access care and their preferences for hypothetical emergency care alternatives. A discrete choice experiment was used to elicit the preferences of Australian adults (n=1529). Mixed logit regression analyses revealed the influence of a range of individual characteristics on preferences and service uptake choices across three different presenting scenarios. Age was associated with service uptake choices in all contexts, whilst the impact of other sociodemographics, health experience and attitudinal factors varied by context. The improvements in explanatory power observed from including these factors in the models highlight the need to further clarify their influence with larger populations and other presenting contexts, and to identify other determinants of preference heterogeneity. The results suggest social marketing programs undertaken as part of demand management efforts need to be better targeted if decision-makers are seeking to increase community acceptance of emerging service models and alternatives. Other implications for health policy, service planning and research, including for workforce planning and the possible introduction of a system of co-payments are discussed.
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Affiliation(s)
- Paul Harris
- School of Medicine, School of Human Services and Social Work, The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Meadowbrook, Queensland 4131, Australia.
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Meadowbrook, Australia.
| | - Julie Ratcliffe
- Institute for Choice, Business School, University of South Australia, Adelaide, South Australia, Australia.
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, NSW, Australia.
| | - Peter Littlejohns
- Division of Health and Social Care Research, King's College School of Medicine, London, United Kingdom.
| | - Paul A Scuffham
- Menzies Health Institute of Queensland, Griffith University, Logan Campus, Nathan, Queensland, Australia.
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Smith H, Currie C, Chaiwuttisak P, Kyprianou A. Patient choice modelling: how do patients choose their hospitals? Health Care Manag Sci 2017; 21:259-268. [PMID: 28401405 DOI: 10.1007/s10729-017-9399-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/08/2017] [Indexed: 11/24/2022]
Abstract
As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient's choice of hospital rather than statistics available on the Internet.
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Harris P, Whitty JA, Kendall E, Ratcliffe J, Wilson A, Littlejohns P, Scuffham PA. The Australian public's preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment. BMJ Open 2015; 5:e006820. [PMID: 25841233 PMCID: PMC4390735 DOI: 10.1136/bmjopen-2014-006820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The current study seeks to quantify the Australian public's preferences for emergency care alternatives and determine if preferences differ depending on presenting circumstances. SETTING Increasing presentations to emergency departments have led to overcrowding, long waiting times and suboptimal health system performance. Accordingly, new service models involving the provision of care in alternative settings and delivered by other practitioners continue to be developed. PARTICIPANTS A stratified sample of Australian adults (n=1838), 1382 from Queensland and 456 from South Australia, completed the survey. This included 951 females and 887 males from the 2045 people who met the screening criteria out of the 4354 people who accepted the survey invitation. INTERVENTIONS A discrete choice experiment was used to elicit preferences in the context of one of four hypothetical scenarios: a possible concussion, a rash/asthma-related problem involving oneself or one's child and an anxiety-related presentation. Mixed logit regression was used to analyse the dependent variable choice and identify the relative importance of care attributes and the propensity to access care in each context. RESULTS Results indicated a preference for treatment by an emergency physician in hospital for possible concussion and treatment by a doctor in ambulatory settings for rash/asthma-related and anxiety-related problems. Participants were consistently willing to wait longer before making trade-offs in the context of the rash/asthma-related scenario compared with when the same problem affected their child. Results suggest a clear preference for lower costs, shorter wait times and strong emphasis on quality care; however, significant preference heterogeneity was observed. CONCLUSIONS This study has increased awareness that the public's emergency care choices will differ depending on the presenting context. It has further demonstrated the importance of service quality as a determinant of healthcare choices. The findings have also provided insights into the Australian public's reactions to emergency care reforms.
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Affiliation(s)
- Paul Harris
- School of Medicine, Population and Social Health Research Program, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Jennifer A Whitty
- Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, St Lucia, Queensland, Australia
| | - Elizabeth Kendall
- Centre of National Research on Disability and Rehabilitation, Population and Social Health Research Program, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Littlejohns
- Division of Health and Social Care Research, King's College School of Medicine, London, UK
| | - Paul A Scuffham
- Centre for Applied Health Economics, Population and Social Health Research Program, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
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Seghieri C, Mengoni A, Nuti S. Applying discrete choice modelling in a priority setting: an investigation of public preferences for primary care models. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:773-785. [PMID: 24241816 PMCID: PMC4145207 DOI: 10.1007/s10198-013-0542-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 11/04/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The shift toward more innovative and sustainable primary care models in Italy leads policy makers and clinicians to face difficult decisions between options that are all regarded as potentially beneficial. In this study, patient preferences for different primary care models in the Tuscany region of Italy were elicited. The relative importance of different attributes to the surveyed respondents was then examined, as well as the rate at which individuals trade between attributes and the relative value of different service configurations. METHODS A discrete choice experiment survey explored the following attributes in a stratified random sample of 6,970 adults: primary care provider, diagnostic facilities and waiting time for the visit. RESULTS Respondents (3,263) were likely to prefer a consultation by their own general practitioner (GP) and a practice with many diagnostic facilities. The predicted utilities of different service configurations have shown that a "primary care centre" with many diagnostic facilities was preferable to a "solo GP" model or a "group general practice". CONCLUSIONS The study demonstrated how a patient choice model could be used by decision makers for developing successful policies that takes into account different healthcare needs, balancing responsiveness with care continuity, equity and appropriateness. Considering that a primary care centre would perform better than a "solo GP", especially for younger respondents and for those with minor healthcare needs, for a more rapid diffusion of this model policymakers and managers could direct the care of primary care centres towards these targeted subgroups, at least in the first phase.
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Affiliation(s)
- Chiara Seghieri
- Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 24, 56127, Pisa, Italy,
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Kløjgaard ME, Hess S. Understanding the formation and influence of attitudes in patients' treatment choices for lower back pain: Testing the benefits of a hybrid choice model approach. Soc Sci Med 2014; 114:138-50. [DOI: 10.1016/j.socscimed.2014.05.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/21/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
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Kløjgaard ME, Manniche C, Pedersen LB, Bech M, Søgaard R. Patient preferences for treatment of low back pain-a discrete choice experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:390-396. [PMID: 24968999 DOI: 10.1016/j.jval.2014.01.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 11/22/2013] [Accepted: 01/19/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Back pain imposes a substantial economic and social burden, and treatment decisions are distorted by conflicting evidence. Thus, it is important to include patient preferences in decision making and policy making. OBJECTIVE To contribute to the understanding of patient preferences in relation to the choice of treatment for low back pain. METHODS A discrete choice experiment was conducted with consecutive patients referred to a regional spine center. The respondents (n = 348) were invited to respond to a choice of two hypothetical treatment options and an opt-out option. The treatment attributes included the treatment modality, the risk of relapse, the reduction in pain, and the expected increase in the ability to perform activities of daily living. In addition, the wait time to achieve the treatment effect was used as a payment vehicle. Mixed logit models were created to perform analysis. Subgroup analysis, dividing respondents into sociodemographic and disease-related categories, further explored the willingness to wait. RESULTS Respondents assigned positive utilities to positive treatment outcomes and disutility to higher risks and longer waits for effects of treatment and to surgical interventions. The model captured significant heterogeneity within the sample for the outcomes of pain reduction and the ability to pursue activities of daily living and for the treatment modality. The subgroup analysis revealed differences in the willingness to wait, especially with regard to treatment modality, the level of pain experienced at the time of data collection, and the respondents' preferences for surgery. CONCLUSIONS The majority of the respondents prefer nonsurgical interventions, but patients are willing to wait for more ideal outcomes and preferred interventions. The results show that health care professionals have a very important task in communicating clearly about the expected results of treatment and the basis of their treatment decisions, as patients' preferences are highly individual.
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Affiliation(s)
| | - Claus Manniche
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Institute of Regional Health Services Research, University of Southern Denmark
| | | | - Mickael Bech
- COHERE - Centre of Health Economics Research, University of Southern Denmark
| | - Rikke Søgaard
- Department of Public Health, Department of Health Services Research, Århus
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Brown S, Henderson E, Howse J, Rubin G. Patient views of single number access to urgent care services. Fam Pract 2012; 29:713-8. [PMID: 22417779 DOI: 10.1093/fampra/cms023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In October 2009, NHS County Durham and Darlington introduced a single point of access telephone number for people requiring out-of-hours health care. We evaluated users' views and experiences of the service. METHODS We used a validated questionnaire adapted for use in telephone interviews, with open-ended questions added to allow people to express their views. Interviews were carried out with 493 people who had used the urgent care line between April and July 2010 of 1626 telephone calls made, a response rate of 30.3%. SPSS 17.0 was used to analyse the quantitative data and Framework analysis the qualitative data. RESULTS We found that (i) regardless of age or gender people who used the call line were satisfied with the service they received, (ii) the call line advised most cases to go to an urgent care centre, (iii) people who received advice other than that expected were still satisfied with the service. Criticisms of the service related to confusion about accessing the service and which number callers should use. CONCLUSIONS We found very high levels of satisfaction across all groups for a single point of access telephone number for urgent care. Clear information about the service, in particular that it will involve telephone triage and that access to a doctor or nurse is not immediate, may also resolve some instances of dissatisfaction. It appears that the service is effective in directing people to places where they can be dealt with appropriately.
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Affiliation(s)
- Sally Brown
- School of Medicine and Health, Queen's Campus, Durham University, University Boulevard, Thornaby on Tees TS17 6BH, UK.
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Ali S, Ronaldson S. Ordinal preference elicitation methods in health economics and health services research: using discrete choice experiments and ranking methods. Br Med Bull 2012; 103:21-44. [PMID: 22859714 DOI: 10.1093/bmb/lds020] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The predominant method of economic evaluation is cost-utility analysis, which uses cardinal preference elicitation methods, including the standard gamble and time trade-off. However, such approach is not suitable for understanding trade-offs between process attributes, non-health outcomes and health outcomes to evaluate current practices, develop new programmes and predict demand for services and products. Ordinal preference elicitation methods including discrete choice experiments and ranking methods are therefore commonly used in health economics and health service research. AREAS OF AGREEMENT Cardinal methods have been criticized on the grounds of cognitive complexity, difficulty of administration, contamination by risk and preference attitudes, and potential violation of underlying assumptions. Ordinal methods have gained popularity because of reduced cognitive burden, lower degree of abstract reasoning, reduced measurement error, ease of administration and ability to use both health and non-health outcomes. AREAS OF CONTROVERSY The underlying assumptions of ordinal methods may be violated when respondents use cognitive shortcuts, or cannot comprehend the ordinal task or interpret attributes and levels, or use 'irrational' choice behaviour or refuse to trade-off certain attributes. CURRENT USE AND GROWING AREAS: Ordinal methods are commonly used to evaluate preference for attributes of health services, products, practices, interventions, policies and, more recently, to estimate utility weights. AREAS FOR ON-GOING RESEARCH: There is growing research on developing optimal designs, evaluating the rationalization process, using qualitative tools for developing ordinal methods, evaluating consistency with utility theory, appropriate statistical methods for analysis, generalizability of results and comparing ordinal methods against each other and with cardinal measures.
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Affiliation(s)
- Shehzad Ali
- Department of Health Sciences, University of York, Heslington, York, UK.
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Hancock-Howard RL, Ungar WJ, Marshall D, Einarson A, Koren G. Public preferences for counseling regarding antidepressant use during pregnancy: A discrete choice experiment. ACTA ACUST UNITED AC 2012; 94:532-9. [DOI: 10.1002/bdra.23042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/11/2022]
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Schwappach DLB, Mülders V, Simic D, Wilm S, Thürmann PA. Is less more? Patients' preferences for drug information leaflets. Pharmacoepidemiol Drug Saf 2011; 20:987-95. [PMID: 21796721 DOI: 10.1002/pds.2212] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 06/20/2011] [Accepted: 06/22/2011] [Indexed: 11/10/2022]
Abstract
PURPOSE Present package information leaflets do not fulfil the needs of many patients. The objective of this study was to investigate patients' preferences towards content and presentation of drug information leaflets using prepared medication brochures in a discrete choice experiment. METHODS 6 binary attributes relating to content and presentation of drug information were used to define and design alternative leaflets. Choice sets between alternative leaflets were created based on an orthogonal design. 1,000 participants aged at least 50 years were presented 8 choice sets of drug information leaflets in a personal interview. The reliability of choices was assessed with a duplicate of one original choice. Regression analysis was used to model the impact of attributes on choices and interactions with responders' age and education. RESULTS Participants slightly preferred colored over black-white leaflets, no visual presentation of side effects by the use of smilies, the provision of a brief summary, and general health tips, but no information on what-to-do in case of side-effects. All attributes except the " extent of side-effects presented" significantly affected participants' choices. Older and less educated participants preferred less information. Of the repeated (duplicate) choices, 84% were replicates of the original choice. Interrater agreement was moderate (K = 0.67, CI 0.6-0.7). 235 subjects (23.5%) followed an optimization strategy and did not trade attributes, i.e., exhibited dominant preferences. CONCLUSIONS In general, participants preferred condensed, plain information in a clear and moderately colored design, but preferences towards drug information are affected by age and level of education.
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Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call. BMC FAMILY PRACTICE 2010; 11:88. [PMID: 21078162 PMCID: PMC2998456 DOI: 10.1186/1471-2296-11-88] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022]
Abstract
Background Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP) on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African) nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.
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Philips H, Remmen R, Van Royen P, Teblick M, Geudens L, Bronckaers M, Meeuwis H. What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care. BMC Health Serv Res 2010; 10:222. [PMID: 20673342 PMCID: PMC2922207 DOI: 10.1186/1472-6963-10-222] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 07/30/2010] [Indexed: 11/30/2022] Open
Abstract
Background Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. Methods We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. Results One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). Conclusions One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.
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Affiliation(s)
- Hilde Philips
- Department of General Practice, University of Antwerp, Universiteitsplein 1, Gebouw R, 3de verd, B-2610 Wilrijk, Belgium.
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Maull RS, Smart PA, Harris A, Karasneh AAF. An evaluation of ‘fast track’ in A&E: a discrete event simulation approach. SERVICE INDUSTRIES JOURNAL 2009. [DOI: 10.1080/02642060902749534] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Urgent health care networks. Prim Health Care Res Dev 2008. [DOI: 10.1017/s1463423608000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Papanikolaou P, Lyne P, Ratcliffe J. Using the discrete choice experimental design to investigate decision-making about pressure ulcer prevention by community nurses. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:588-598. [PMID: 17956411 DOI: 10.1111/j.1365-2524.2007.00728.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study investigates the preferences of senior community nurses who work as district nurse team leaders in selecting preventive care plans for elderly people at high risk of pressure ulcer formation. The discrete choice experiment (DCE) technique was used. Focus group work produced the following five attributes of nurse decision-making: 'ease of care plan management', 'impact of care plan on patient's lifestyle', 'speed of obtaining the equipment', 'affordability', 'evidence-based practice'. These were incorporated into a self-administered questionnaire, posted to 102 nurses from two integrated acute/community NHS Trusts in Wales. A response rate of 55% was achieved. Respondents were asked to rate the importance of the selected attributes on a 5-point scale. They rated 'evidence-based practice', 'impact of care plan on patient's lifestyle', 'ease of care plan management' and 'speed of obtaining the equipment' highly, whereas 'affordability' was of less importance. However, regression analysis, which is part of the DCE technique, produced a somewhat different picture, with 'impact' being least and 'affordability' most statistically significant. The reasons for this apparent anomaly are discussed and the paper concludes that the DCE approach is capable of yielding important information, which is not produced by simple rating exercises. Such information is potentially of value in the context of modernisation and service configuration.
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Affiliation(s)
- Panos Papanikolaou
- Nursing, Health and Social Care Research Centre, School of Nursing and Midwifery Studies, Cardiff University, 35-43 Newport Road, Cardiff, UK.
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Gerard K, Lattimer V, Surridge H, George S, Turnbull J, Burgess A, Lathlean J, Smith H. The introduction of integrated out-of-hours arrangements in England: a discrete choice experiment of public preferences for alternative models of care. Health Expect 2006; 9:60-9. [PMID: 16436162 PMCID: PMC5060322 DOI: 10.1111/j.1369-7625.2006.00365.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To establish which generic attributes of general practice out-of-hours health services are important to the public. METHODS A discrete choice experiment postal survey conducted in three English general practitioner (GP) co-operatives. A total of 871 individuals aged 20-70 years registered with a GP. Outcomes were preferences for, and trade-offs between: time to making initial contact, time waiting for advice/treatment, informed of expected waiting time, type of contact, professional providing advice, chance contact relieves anxiety, and utility estimates for valuing current models of care. RESULTS Response rate was 37%. Respondents valued out-of-hours contact for services for reducing anxiety but this was not the only attribute of importance. They had preferences for the way in which services were organized and valued information about expected waiting time, supporting findings from elsewhere. Participants were most willing to make trade-offs between waiting time and professional person. Of the predicted utility for three models of care utility was higher for fully integrated call management. CONCLUSIONS Greater utility might be achieved if existing services are re-configured more in line with the government's fully integrated call management model. Because the attributes were described in generic terms, the findings can be applied more generally to the plethora of models that exist (and many that might exist in the future). The approach used is important for achieving greater public involvement in how health services develop. Few experiments have elicited public preferences for health services in the UK to date. This study showed valid preferences were expressed but there were problems obtaining representative views from the public.
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Affiliation(s)
- Karen Gerard
- School of Nursing and Midwifery, University of Southampton, Southampton, UK.
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Ryan M, Watson V. Counting the cost of fast access: using discrete choice experiments to elicit preferences in general practice. Br J Gen Pract 2006; 56:4-5. [PMID: 16438808 PMCID: PMC1821424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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