患者偏好的属性,表征替代模式的护理在胃肠病学:一个离散选择实验。

IF 3.4 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Rumbidzai N Mutsekwa, Katrina L Campbell, Russell Canavan, Brendan Mulhern, Rebecca L Angus, Joshua M Byrnes
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引用次数: 0

摘要

目的:对胃肠病学服务的需求增加导致等待名单增加,患者面临超过临床推荐等待时间的风险。鉴于有限的医疗资源,扩大范围的护理模式是一个选项,以帮助解决这一需求,但很少了解患者的偏好,这些模式的护理。方法:低风险胃肠病患者(n = 1198)被邀请参加一个无标签的离散选择实验,该实验有7个属性:初级卫生保健专业人员、等待时间、护理连续性、咨询时间、方式和沟通技巧、保证和费用。这些都是通过定性研究、文献回顾和利益相关者的经验发展起来的。一个d-efficient分数设计被用来构建4块12个选择集,有两个选择集。第13个选择集作为数据和质量检查。使用潜类回归和混合logit回归进行分析。所得的个人属性偏好参数被用来计算支付意愿和等待意愿。结果:总体而言,基于347名受访者的模型显示对专业背景的偏好不强。所有其他属性都是统计上显著的偏好预测因子(p < 0.001),受访者愿意在接受属性恶化之前做出重大权衡(时间和成本)。他们非常强调举止和沟通技巧,最重要的是医生能倾听并提供良好的解释。潜在类别分析确定了两个不同的患者群体,他们对主要治疗保健专业人员(医生或营养师)的偏好不同,这是基于对传统医学或非医学专业角色替代模型的暴露。结论:患者对胃肠病学服务有强烈但不同的偏好,这取决于他们是否接触过扩大范围的护理模式。新护理模式的设计和实施需要考虑策略,以克服那些不熟悉专业角色替代的人在效用上的任何感知损失或医疗保健质量的恶化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment.

Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment.

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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来源期刊
Patient-Patient Centered Outcomes Research
Patient-Patient Centered Outcomes Research HEALTH CARE SCIENCES & SERVICES-
CiteScore
6.60
自引率
8.30%
发文量
44
审稿时长
>12 weeks
期刊介绍: The Patient provides a venue for scientifically rigorous, timely, and relevant research to promote the development, evaluation and implementation of therapies, technologies, and innovations that will enhance the patient experience. It is an international forum for research that advances and/or applies qualitative or quantitative methods to promote the generation, synthesis, or interpretation of evidence. The journal has specific interest in receiving original research, reviews and commentaries related to qualitative and mixed methods research, stated-preference methods, patient reported outcomes, and shared decision making. Advances in regulatory science, patient-focused drug development, patient-centered benefit-risk and health technology assessment will also be considered. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in The Patient may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances. All manuscripts are subject to peer review by international experts.
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