What patients want from primary care consultations: A discrete choice experiment to identify patients' priorities
What patients want from primary care consultations: A discrete choice experiment to identify patients' priorities
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DOI：
10.1370/afm.816
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发表时间：
2008-03-01
影响因子：
4.4
通讯作者：
Roland, Martin
中科院分区：
文献类型：
--
作者：
Cheraghi-Sohi, Sudeh;Hole, Arne Risa;Roland, Martin
会诊是提供初级保健的基础，但组织会诊的不同方式可能会导致患者在可及性、连续性、护理技术质量和沟通方面的不同体验。需要了解患者对这些不同问题的优先级，但评估优先级的最佳方法尚不清楚。本研究采用离散选择实验来评估患者的优先级。方法我们调查了来自英国6个家庭诊所的患者。患者对初级保健咨询的选择具有不同的属性，如访问的便利性（等待预约）、选择（预约时间的灵活性）、连续性（医生对患者的了解）、技术质量（身体检查的彻彻性）以及以患者为中心的护理的多个方面（对患者想法的兴趣、对患者社会和情感健康的询问以及患者参与决策）。我们使用概率模型来评估患者对不同属性的相对优先级，并估计他们愿意为此支付多少钱。结果：分析基于1193例患者的反应（反应率53%）。总体而言，患者愿意为彻底的身体检查支付最多的费用（40.87美元）。其次最受重视的护理属性是看一个熟悉他们的医生（12.18美元），看一个友好的医生（8.50美元），减少一天的等待时间（7.22美元），以及预约时间的灵活性（6.71美元）。患者对以患者为中心的护理的不同方面的评价相似（12.06- 14.82美元）。反应受到做出决定的情景（轻微身体问题vs紧急身体问题vs模棱两可的身体或心理问题）和患者人口统计学特征的影响。结论：虽然以患者为中心的护理对患者很重要，但他们可能更重视护理的技术质量和护理的连续性。离散选择实验可能是评估患者在医疗保健中的优先事项的有用方法。
PURPOSE The consultation is fundamental to the delivery of primary care, but different ways of organizing consultations may lead to different patient experiences in terms of access, continuity, technical quality of care, and communication. Patients' priorities for these different issues need to be understood, but the optimal methods for assessing priorities are unclear. This study used a discrete choice experiment to assess patients' priorities.METHODS We surveyed patients from 6 family practices in England. The patients chose between primary care consultations differing in attributes such as ease of access (wait for an appointment), choice (flexibility of appointment times), continuity (physician's knowledge of the patient), technical quality (thoroughness of physical examination), and multiple aspects of patient-centered care (interest in patient's ideas, inquiry about patient's social and emotional well-being, and involvement of patient in decision making). We used probit models to assess the relative priority patients placed on different attributes and to estimate how much they were willing to pay for them.RESULTS Analyses were based on responses from 1,193 patients (a 53% response rate). Overall, patients were willing to pay the most for a thorough physical examination ($40.87). The next most valued attributes of care were seeing a physician who knew them well ($12.18), seeing a physician with a friendly manner ($8.50), having a reduction in waiting time of I day ($7.22), and having flexibility of appointment times ($6.71). Patients placed similar value on the different aspects of patient-centered care ($12.06-$14.82). Responses were influenced by the scenario in which the decision was made (minor physical problem vs urgent physical problem vs ambiguous physical or psychological problem) and by patients' demographic characteristics.CONCLUSIONS Although patient-centered care is important to patients, they may place higher priority on the technical quality of care and continuity of care. Discrete choice experiments may be a useful method for assessing patients' priorities in health care.