Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.
Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.
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DOI：
10.1371/journal.pone.0135621
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Kruk ME
中科院分区：
文献类型：
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作者：
Larson E;Vail D;Mbaruku GM;Kimweri A;Freedman LP;Kruk ME
为了发展以患者为中心的护理，我们需要知道患者想要什么，以及不断变化的社会人口因素如何影响他们的偏好。我们进行了一项结构化问卷调查，其中包括一个离散选择实验，以调查坦桑尼亚Pwani地区四个农村地区妇女对分娩护理地点的偏好。离散选择实验包括六个属性：卫生工作者的善待、卫生工作者的医学知识、现代设备和药物、设施隐私、设施清洁度和就诊费用。每位女性都有8道选择题。使用混合logit模型评估潜在的供给侧和需求侧因素对患者偏好的影响。3003名女性参加了离散选择实验（93%的回复率），完成了23947项选择任务。对卫生设施偏好的最大预测因子是医生的善待（β = 1.13, p<0.001），其次是拥有优秀医学知识的医生（β = 0.89 p<0.001）和现代化的医疗设备和药物（β = 0.66 p<0.001）。除了善良和成本之外，所有属性的偏好都随着教育程度、初产、媒体接触和到最近医院的距离的变化而变化。护理质量，包括技术和人际关系，比诊所投入更重要，如设备和清洁。这些结果表明，虽然基本的诊所基础设施是必要的，但它不足以提供高质量的、以患者为中心的护理。迫切需要建立一支足够的、有能力的和善良的卫生工作队伍，以提高设施提供和促进以患者为中心的护理。
In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences. We fielded a structured questionnaire that included a discrete choice experiment to investigate women’s preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models. 3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital. Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.