Heterogeneity in Preferences for Primary Care Consultations: Results from a Discrete Choice Experiment
DOI:
https://doi.org/10.6000/1929-6029.2013.02.01.08Keywords:
Physician-patient relations, primary care, public preference elicitation, patient-centred care, discrete choice experimentAbstract
Purpose: The increasing importance of flexibility in the general practitioner (GP) -patient consultation approach in primary care requires healthcare managers and physicians to find a balance among all the potentially important characteristics of consultation. This study used a discrete choice experiment (DCE) to assess patients’ preferences for different attributes of GP consultation and how the rate at which they traded between different attributes is affected by socio-demographic characteristics and past experiences with primary care services .
Methods: A survey was conducted to a sample of 6970 residents in Tuscany region, Italy. Besides socio-demographic characteristics the survey collected information about participants’ past experience with GP consultation in the last 12 months. Moreover, participants were asked to select their preferred option in a series of pairwise choices, defined by the following attributes: level of involvement in decision making, amount of information received from the GP and waiting time for the visit.
Results: Results revealed that receiving information from the GP was more important than being involved in the decisions and that, approximately, a complete involvement had the same importance as a partial involvement. Participants' past experience with GP’s consultation appeared to have the greatest influence on the involvement level. The amount of information required by the respondents was also influenced by a complex interplay of personal and contextual factors.
Conclusions: This large-scale study extends the body of literature on DCE applications for different GP consultation approaches, providing new information about the influence that patients’ socio-demographic characteristics and past experiences could have on consultation preferences.
References
Mead N, Bower P. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Couns 2002; 48(1): 51-61. http://dx.doi.org/10.1016/S0738-3991(02)00099-X DOI: https://doi.org/10.1016/S0738-3991(02)00099-X
Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 2001; 4: CD003267. DOI: https://doi.org/10.1002/14651858.CD003267
Ryan M. Agency in Health Care: lessons for economists from sociologists. Am J Econ Sociol 1994, 53(2): 207-17. http://dx.doi.org/10.1111/j.1536-7150.1994.tb02588.x DOI: https://doi.org/10.1111/j.1536-7150.1994.tb02588.x
Scott A, Vick S. Patients, doctor and contracts: an application of principal-agent theory of the doctor-patient relationship. Scott J Polit Econ 1999; 46: 111-34. http://dx.doi.org/10.1111/1467-9485.00124 DOI: https://doi.org/10.1111/1467-9485.00124
Williams A. Priority setting in public and private health care. A guide through the methodological jungle. J Health Econ 1988; 7: 173-83. http://dx.doi.org/10.1016/0167-6296(88)90015-X DOI: https://doi.org/10.1016/0167-6296(88)90015-X
Evans RG. Strained Mercy. The economics of Canadian health care. Butterworths, Toronto 1984.
Krupat E, Yeager CM, Putnam S. Patient role orientations, doctor-patient fit, and visit satisfaction. Psychol Health 2000; 15(5): 707-19. http://dx.doi.org/10.1080/08870440008405481 DOI: https://doi.org/10.1080/08870440008405481
Coulter A. What do patients and the public want from primary care? BMJ 2005; 331:1199-201. http://dx.doi.org/10.1136/bmj.331.7526.1199 DOI: https://doi.org/10.1136/bmj.331.7526.1199
Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision - making in clinical practice: Update of a systematic review of health professionals’ perceptions. Patient Educ Couns 2008; 73(3): 526-35. http://dx.doi.org/10.1016/j.pec.2008.07.018 DOI: https://doi.org/10.1016/j.pec.2008.07.018
Vick S, Scott A. Agency in health care. Examining patients’ preferences for attributes of the doctor-patient relationship. J Health Econ 1998; 17: 587-605. http://dx.doi.org/10.1016/S0167-6296(97)00035-0 DOI: https://doi.org/10.1016/S0167-6296(97)00035-0
Longo MF, Cohen DR, Hood K, Edwards A, Robling M, Elwin G, et al. Involving patients in primary care consultation: assessing preferences using discrete choice experiments. Br J Gen Pract 2006; 56: 35-42.
Cheraghi-Sohi S, Hole AR, Mead N, McDonald R, Whalley D, Bower P, et al. What Patients Want From Primary care Consultation: A Discrete Choice Experiment to Identify Patients’ Priorities. Ann Fam Med 2008; 6(2): 107-15. http://dx.doi.org/10.1370/afm.816 DOI: https://doi.org/10.1370/afm.816
De Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ 2010; 21(2): 145-72. http://dx.doi.org/10.1002/hec.1697 DOI: https://doi.org/10.1002/hec.1697
Edwards M, Davies M, Edwards A. What are the external influences on information exchange and shared decision making in healthcare consultations: a meta-synthesis of the literature. Patient Educ Couns 2009; 75(1): 37-52. http://dx.doi.org/10.1016/j.pec.2008.09.025 DOI: https://doi.org/10.1016/j.pec.2008.09.025
Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract 2001; 50(12): 1057-62.
Charles C, Gafni A, Whelan T. Decision making in the physician-patient encounter: revisiting the shared treatment. Soc Sci Med 1999; 49(5): 651-61. http://dx.doi.org/10.1016/S0277-9536(99)00145-8 DOI: https://doi.org/10.1016/S0277-9536(99)00145-8
Ryan M, Gerard K. Using discrete choice experiments to value health care programmes: current practice and future research reflections. Applied Health Econ Health Policy 2003; 2(1): 55-64.
Torbica A, Fattore G. Understanding the impact of economic evidence on clinical decision making: A discrete choice experiment in cardiology. Soc Sci Med 2010; 70(10): 1536-43. http://dx.doi.org/10.1016/j.socscimed.2009.12.030 DOI: https://doi.org/10.1016/j.socscimed.2009.12.030
Salkeld G, Solomon M, Short L, Ward J. Measuring the importance of attributes that influence consumer attitudes to colorectal cancer screening. ANZ J Surgery 2003; 73(3), 128-32. http://dx.doi.org/10.1046/j.1445-2197.2003.02650.x DOI: https://doi.org/10.1046/j.1445-2197.2003.02650.x
Gerard K, Lattimer V, Surridge H, George S, Turnbull J, Burgess A, et al. The introduction of integrated out-of-hours arrangements in England: a discrete choice experiment of public preference for alternative models of care. Health Expect 2006; 9: 60-69. http://dx.doi.org/10.1111/j.1369-7625.2006.00365.x DOI: https://doi.org/10.1111/j.1369-7625.2006.00365.x
Viney R, Lancsar E, Louviere J. Discrete choice experiments to measure consumer preferences for health and healthcare. Expert Rev Pharmacoecon Outcomes Res 2002; 2(4): 319-26. http://dx.doi.org/10.1586/14737167.2.4.319 DOI: https://doi.org/10.1586/14737167.2.4.319
Street DJ, Burgess L, Louviere JJ. Quick and easy choice sets: Constructing optimal and nearly optimal stated choice experiments. IJRM 2005; 22: 459-70 DOI: https://doi.org/10.1016/j.ijresmar.2005.09.003
Huber J, Zwerina K. The Importance of Utility Balance in Efficient Choice Designs. J Mark Res 1996; 33: 307-17. http://dx.doi.org/10.2307/3152127 DOI: https://doi.org/10.1177/002224379603300305
Murante AM. Valutazione esterna. In: MeS Lab. (ed). Il Sistema di valutazione della performance della sanità Toscana - Report 2009. ETS, Pisa 2010; pp. 268-272.
Burge P, Devlin N, Appleby J, Gallo F, Nason E, Ling T. Understanding Patients’ Choices at the Point of Referral. RAND Corporation 2006.
Perkins WS, Roundy J. Discrete choice surveys by telephone. JAMS 1993; 21(1): 33-38. http://dx.doi.org/10.1177/0092070393211004 DOI: https://doi.org/10.1177/0092070393211004
McFadden D. Conditional logit analysis of qualitative choice behaviour. In: Zarembka P. (ed). Frontiers in Econometrics. Academic Press, New York 1974; pp. 105-142.
Propper C. The Disutility of Time Spent on the United Kingdom’s National Health Services Waiting Lists. J Hum Resour 1995; 30(4): 677-700. http://dx.doi.org/10.2307/146227 DOI: https://doi.org/10.2307/146227
Bech M, Gyrd-Hansen D. Effects coding in discrete choice experiments. Health Econ 2005; 14(10): 1079-83. http://dx.doi.org/10.1002/hec.984 DOI: https://doi.org/10.1002/hec.984
Efron B. Bootstrap methods another look at the jackknife. Ann Stat 1979; 7: 1-26. http://dx.doi.org/10.1214/aos/1176344552 DOI: https://doi.org/10.1214/aos/1176344552
Scott A. Identifying and analysing dominant preferences in discrete choice experiments: An application in health care. J Econ Psychol 2002; 23: 383-98. http://dx.doi.org/10.1016/S0167-4870(02)00082-X DOI: https://doi.org/10.1016/S0167-4870(02)00082-X
Morgan A, Shackley P, Pickin M, Brazier J. Quantifying patient preferences for out-of-hours primary care. J Health Serv Res Policy 2000; 5(4): 214-18. DOI: https://doi.org/10.1177/135581960000500405
Scott A, Watson M, Ross S. Eliciting preferences of the community for out of hours care provided by general practitioners: a stated preference discrete choice experiment. Soc Sci Med 2003; 56: 803-14. http://dx.doi.org/10.1016/S0277-9536(02)00079-5 DOI: https://doi.org/10.1016/S0277-9536(02)00079-5
Howard K, Salkeld G. Does attribute framing in discrete choice experiments influence willingness to pay? Results from a discrete choice experiment in screening for colorectal cancer. Value Health 2009; 12(2). 354-63. http://dx.doi.org/10.1111/j.1524-4733.2008.00417.x DOI: https://doi.org/10.1111/j.1524-4733.2008.00417.x
Phillips KA, Maddala T, Johnson F. Measuring Preferences for Health Care Interventions Using Conjoint Analysis: An Application to HIV Testing. Health Serv Res 2002; 37(6) 1681-705. http://dx.doi.org/10.1111/1475-6773.01115 DOI: https://doi.org/10.1111/1475-6773.01115
Maddala T, Philips KA, Johnson FR. An experiment of simplifying conjoint analysis designs for measuring preferences. Health Econ 2003; 12(12): 1035-47. http://dx.doi.org/10.1002/hec.798 DOI: https://doi.org/10.1002/hec.798
Buja A, Cavinato M, Perissinotto E, Rausa G, Mastrangelo G, Toffanin R. Why do patients change their general practitioner? Suggestions on corrective actions. Ir J Med Sci 2011; 180: 149-54. http://dx.doi.org/10.1007/s11845-010-0571-6 DOI: https://doi.org/10.1007/s11845-010-0571-6
Guadagnoli E, Ward P. Patient participation in decision-making. Soc Sci Med1998; 47(3): 329-39. http://dx.doi.org/10.1016/S0277-9536(98)00059-8 DOI: https://doi.org/10.1016/S0277-9536(98)00059-8
Benbassat J, Pilpel D, Tidhar M. Patients’ preferences for participation in clinical decision making: a review of published surveys. Behav Med 1998; 24(2): 81-88. http://dx.doi.org/10.1080/08964289809596384 DOI: https://doi.org/10.1080/08964289809596384
Robinson A, Thomson R. Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools. Qual Health Care 2001; 10(Suppl 1): i34-i38. http://dx.doi.org/10.1136/qhc.0100034 DOI: https://doi.org/10.1136/qhc.0100034
Levinson W, Kao A, Kuby A, Thisted R. Not all patients want to participate in decision making. A national study of public preferences. J Gen Intern Med 2005; 20(6): 531-35. http://dx.doi.org/10.1111/j.1525-1497.2005.04101.x DOI: https://doi.org/10.1111/j.1525-1497.2005.04101.x
Cecil DW, Killeen I. Control, compliance, and satisfaction in the family practice encounter. Fam Med 1997; 29(9): 653-7.
Auerbach SM. Should patients have control over their own health care? Empirical evidence and research issues. Ann Behav Med 2000; 22(3): 246-59. http://dx.doi.org/10.1007/BF02895120 DOI: https://doi.org/10.1007/BF02895120
Makoul G. Perpetuating passivity: reliance and reciprocal determinism in physician–patient interaction. J Health Commun 1998; 3(3): 233-59. http://dx.doi.org/10.1080/108107398127355 DOI: https://doi.org/10.1080/108107398127355
Coulter A, Peto V, Doll H. Patients’ preferences and general practitioners’ decisions in the treatment of menstrual disorders. Fam Pract1994; 11(1): 67-74. http://dx.doi.org/10.1093/fampra/11.1.67 DOI: https://doi.org/10.1093/fampra/11.1.67
Hall JA, Stein TS, Roter DL, Rieser N. Inaccuracies in physicians’ perceptions of their patients. Med Care 1999; 37(11): 1164-68. http://dx.doi.org/10.1097/00005650-199911000-00008 DOI: https://doi.org/10.1097/00005650-199911000-00008
Hulsman RL, Ros WJ, Winnubst JA, Bensing JM. Teaching clinically experienced physicians communication skills. A review of evaluation studies. Med Educ 1999; 33(9): 655-68. http://dx.doi.org/10.1046/j.1365-2923.1999.00519.x DOI: https://doi.org/10.1046/j.1365-2923.1999.00519.x
Krantz DS, Baum A, Wideman M. Assessment of preferences for self-treatment and information in health care. J Pers Soc Psychol 1980; 39(5): 977-90. http://dx.doi.org/10.1037/0022-3514.39.5.977 DOI: https://doi.org/10.1037/0022-3514.39.5.977
Degner LF, Kristjanson LJ, Bowman D, Sloan, JA, Carriere KC, O’Neil J, et al. Information needs and decisional preferences in women with breast cancer. JAMA 1997; 277: 1485-92. http://dx.doi.org/10.1001/jama.1997.03540420081039 DOI: https://doi.org/10.1001/jama.277.18.1485
Post DM, Cegala DJ, Miser WF. The other half of the whole: teaching patients to communicate with physicians. Fam Med 2002; 34(5): 344-52.
Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns 2004; 52(1): 7-16. http://dx.doi.org/10.1016/S0738-3991(03)00017-X DOI: https://doi.org/10.1016/S0738-3991(03)00017-X
Lauver DR, Ward SE, Heidrich SM, Keller ML, Bowers BJ, Brennan PF, Kirchhoff KT, Wells TJ. Patient-centered interventions. Res Nurs Health 2002; 25(4): 246-55. http://dx.doi.org/10.1002/nur.10044 DOI: https://doi.org/10.1002/nur.10044
Say R, Murtagh M, Thomson R. Patients’ preference for involvement in medical decision making: a narrative review. Patient Educ Couns 2006; 60(2): 102-14. http://dx.doi.org/10.1016/j.pec.2005.02.003 DOI: https://doi.org/10.1016/j.pec.2005.02.003
Swenson SL, Buell S, Zettler P, White M, Ruston DC, Lo B. Patient-centered communication: do patients really prefer it? J Gen Intern Med 2004; 19(11): 1069-79. http://dx.doi.org/10.1111/j.1525-1497.2004.30384.x DOI: https://doi.org/10.1111/j.1525-1497.2004.30384.x
Keating NL, Guadagnoli E, Landrum MB, Borbas C, Weeks JC. Treatment decision making in early-stage breast cancer: should surgeons match patients’ desired level of involvement? J Clin Oncol 2002; 20(6): 1473-79. http://dx.doi.org/10.1200/JCO.20.6.1473 DOI: https://doi.org/10.1200/JCO.2002.20.6.1473
Richardson G, Bojke C, Kennedy A, Reeves D, Bower P, Lee V, et al. What Outcomes Are Important to Patients with Long Term Conditions? A Discrete Choice Experiment. Value Health 2009; 12(2): 331-39. http://dx.doi.org/10.1111/j.1524-4733.2008.00419.x DOI: https://doi.org/10.1111/j.1524-4733.2008.00419.x
Green C, Gerard K. Exploring the social value of health-care interventions: a stated preference discrete choice experiment. Health Econ 2009; 18(8): 951-76. http://dx.doi.org/10.1002/hec.1414 DOI: https://doi.org/10.1002/hec.1414
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2013 Alessandro Mengoni, Chiara Seghieri, Sabina Nuti
This work is licensed under a Creative Commons Attribution 4.0 International License.
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
