Evaluating the concordance of physician judgments and patient preferences on AIDS/HIV therapy - a Discrete Choice Experiment.
Evaluating the concordance of physician judgments and patient preferences on AIDS/HIV therapy - a Discrete Choice Experiment.
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DOI：
10.1186/2191-1991-3-30
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发表时间：
2013-12-18
影响因子：
2.4
通讯作者：
Nübling M
中科院分区：
文献类型：
--
作者：
Mühlbacher AC;Stoll M;Mahlich J;Nübling M
以患者为中心的医疗保健和共同决策在艾滋病/艾滋病毒患者的管理中越来越重要，需要充分考虑患者的偏好。本研究从医生的角度评估患者的期望和需求。本研究的目的是比较患者和医生对治疗质量相关方面的看法，如疗效、生活质量和进一步的治疗选择。这项研究是以匿名调查的方式进行的，调查对象包括德国医生。最好联系治疗大量艾滋病/艾滋病毒患者的医生。医生被要求评估他们的观点，病人的治疗特点的偏好使用直接测量，以及通过离散选择实验（DCE）的手段。该问卷采用了先前的一项研究，该研究要求艾滋病/艾滋病毒患者评估他们的治疗偏好。131名医生完成了调查问卷，其中88%是书面问卷，12%是在线问卷。70%的医生是男性。自获得执照以来的平均持续时间为17年。最常见的专科是内科（55例）、感染（31例）和全科（27例）。在直接测量中，最相关的治疗特征是“药物不影响或不太影响外观”、“可以自行用药”和“很少发生较长时间的恶心和腹泻”。选择六个治疗特征并用于生成八个虚拟治疗对。采用随机效应logit模型对评价结果进行评价。鉴于医生回避了对疾病的明显感知，生活的情绪质量迄今为止对医生评价的患者治疗偏好的影响最大。随着距离的增加，腹泻或恶心的身体生活质量减少，以及参与社会生活的可能性也在同一水平上。离散选择实验被证明是一种有效的调查技术，用于评估艾滋病/艾滋病毒治疗偏好，由患者和医生评估患者的观点。涵盖广泛的治疗特征，医生对偏好的评估非常接近艾滋病/艾滋病毒患者的评估，强调生活质量的高度影响，特别是情感生活质量对患者选择治疗偏好的影响。因此，在选择特定的治疗方案时，应慎重考虑治疗特点，以最大限度地提高患者的依从性和依从性。
Patient-centered health care and shared decision making are of increasing importance in the management of AIDS/HIV patients and require an intensive consideration of patient preferences. The present study assesses expectations and needs of patients from the physician point of view. The aim of this study was to compare patient and physician perspectives of relevant aspects of treatment quality such as effectiveness, quality of life and further treatment options. The study was performed as an anonymous survey including German physicians. Physicians treating large numbers of AIDS/HIV patients were preferably contacted. The physicians were asked to assess their view of patient preferences of therapy characteristics using direct measurement, as well as by means of a Discrete Choice Experiment (DCE). The questionnaire was adopted from a previous study in which AIDS/HIV patients were asked to assess their treatment preferences. 131 physicians completed the questionnaire, 88% of these on paper and 12% online. 70% of the physicians were male. The mean duration since licensure was 17 years. The most frequent specialist areas were internal medicine (N = 55), infectiology (N = 31) and general medicine (N = 27). In the direct measurement the most relevant therapy characteristics were “drug does not affect or not affect appearance much”, “self-application of the drug is possible” and “rarely occurring longer periods of nausea and diarrhea”. Six treatment characteristics were selected and used to generate eight virtual pairs of therapies. To evaluate the assessments a random effect logit model was employed. In view of the physicians avoidance of an obvious perceptibility of the disease the emotional quality of life had by far the strongest impact on the patients’ treatment preferences as rated by physicians. With some distance the physical quality of life with less diarrhea or nausea, as well as the possibility to participate in social life followed on the same level. Discrete Choice Experiment proved to be a valid survey technique in the evaluation of AIDS/HIV treatment preferences as assessed by patients and by physicians assessing the view of their patients. Covering a broad range of treatment characteristics, the physician assessments of preferences were very close to those of AIDS/HIV patients emphasizing the high impact of quality of life, in particular the emotional quality of life on patient preferences in the selection of treatments. Thus, the selection of particular treatment options should be accompanied by a deliberate consideration of treatment features, which need to be considered in order to maximize patient adherence and compliance.