Article Figures & Data
Figures
- Figure 1.
Structure of the discrete choice questionnaire.
Tables
Quality Concept Attribute Levels a Attributes shared across questionnaires. Generic questionnaire Access Number of days wait for an appointmenta Same day, next day, 2 days, 5 days Cost Cost of appointment to patienta £0, £8, £18, £28 ($0, $16.27, $36.60, $56.93) Choice Flexibility of appointment times One appointment offered Choice of appointment times offered Interpersonal care Physician’s interpersonal manner Warm and friendly Formal and businesslike Relational continuity Physician’s knowledge of the patienta The doctor has access to your medical notes and knows you well The doctor has access to your medical notes but does not know you Technical care Thoroughness of physical examination The doctor gives you a thorough examination The doctor’s examination is not very thorough Patient-centered care questionnaire Access Number of days’ wait for an appointmenta Same day, next day, 2 days, 5 days Cost Cost of appointment to patienta £0, £8, £18, £28 ($0, $16.27, $36.60, $56.93) Relational continuity Physician’s knowledge of the patienta The doctor has access to your medical notes and knows you well The doctor has access to your medical notes but does not know you Patient-centered care Patient perspective The doctor is interested in your own ideas about what is wrong The doctor is not interested in your own ideas about what is wrong Patient-centered care Biopsychosocial perspective The doctor asks about your social and emotional well-being as well as physical symptoms The doctor asks about your physical symptoms only Patient-centered care Shared decision making The doctor involves you in decisions about treatment The doctor does not involve you in decisions about treatment Scenario Description Minor physical problem I want you to imagine that you have developed some itchy, flaky patches on your hands. Occasionally they become quite red and sore. The problem does not appear to be spreading but has not responded to ointment recommended by the chemist. You decide to seek a medical opinion. Urgent physical problem I want you to imagine that you have a heavy cough and cold. Over the past 2 days you have started to get some pain in the right side of your chest. It is very sharp and worse if you cough or take a deep breath in. You decide to seek a medical opinion. Ambiguous physical or psychological problem I want you to imagine that you are in your current state of health but over the last few months you have been feeling tired and irritable and have had difficulty sleeping. You have tried several things yourself to remedy this but are not feeling any better. You decide to seek a medical opinion. Characteristic Generic Questionnaire (n=628)a Patient-Centered Care Questionnaire (n=565)a a Total number of respondents in the estimation sample. Where variables have missing values, the percentages are calculated based on the nonmissing observations. Female, % 55.0 52.4 Age, mean (SD), years 52.5 (17.9) 53.0 (18.3) Number of dependent children in household, % 0 70.1 71.7 1–2 26.4 23.6 ≥3 3.5 4.7 Household income, % <£20,000 49.1 45.9 £20,000–£39,999 35.1 34.4 £40,000–£59,999 11.5 14.7 ≥£60,000 4.3 4.9 Have a long-term illness, % 46.1 45.7 White, % 94.7 95.7 Overall health is “good” or “very good,” % 59.5 63.3 Number of visits to physician in past 12 months, % ≤2 44.4 50.5 3–4 26.7 24.3 ≥5 28.9 25.2 Own/have a mortgage on their residence, % 76.2 76.7 Attribute or Variable All Scenarios Ambiguous Physical/Psychological Scenario Minor Physical Scenario Urgent Physical Scenario a P<.001. b P<.05. Note: ρ2 is a measure of goodness of fit of the discrete choice model. It is given by 1 − LL(β̂)/LL(0), where LL(β̂) is the log-likelihood of the reported models and LL(0) is the log-likelihood of a constant-only model. Generic questionnaire Attribute Coefficient t Coefficient t Coefficient t Coefficient t Waiting time, days −0.114a −21.80 −0.053a −5.81 −0.074a −7.72 −0.210a −21.82 Cost, £ −0.032a −40.22 −0.032a −23.12 −0.044a −29.79 −0.023a −16.58 Doctor knows you well 0.192a 12.23 0.302a 10.62 0.210a 7.24 0.130a 4.75 You get a choice of appointment times 0.105a 6.73 0.031 1.11 0.120a 4.09 0.137a 5.03 Doctor is warm and friendly 0.134a 8.55 0.145a 5.29 0.187a 6.42 0.070b 2.59 Doctor gives you a thorough physical examination 0.643a 39.28 0.756a 25.50 0.599a 19.50 0.679a 23.40 Constant −0.004 −0.20 −0.004 −0.12 −0.023 −0.70 0.020 0.62 Variable Value Value Value Value Number of responses 9,953 3,343 3,243 3,367 Number of respondents 628 421 409 425 ρ2 0.303 0.326 0.374 0.321 Patient-centered care questionnaire Attribute Coefficient t Coefficient t Coefficient t Coefficient t Waiting time, days −0.119a −22.08 −0.055a −5.65 −0.069a −7.30 −0.229a −23.04 Cost, £ −0.035a −43.14 −0.036a −25.48 −0.043a −29.34 −0.029a −20.00 Doctor knows you well 0.305a 18.70 0.317a 10.88 0.359a 12.03 0.301a 10.39 Doctor is interested in your ideas 0.254a 15.87 0.292a 10.26 0.305a 10.50 0.225a 7.86 Doctor asks about your social and emotional well-being 0.216a 13.01 0.420a 13.91 0.195a 6.53 0.075b 2.59 Doctor involves you in decision making 0.207a 13.06 0.273a 9.86 0.225a 7.92 0.156a 5.44 Constant 0.002 0.12 −0.004 −0.11 0.006 0.16 0.042 1.25 Variable Value Value Value Value Number of responses 9,009 2,966 3,036 3,007 Number of respondents 565 372 381 377 ρ2 0.287 0.308 0.362 0.317 Willingness to Pay, $ (95% CI) Attribute All Scenarios Ambiguous Physical/Psychological Scenario Minor Physical Scenario Urgent Physical Scenario CI=confidence interval. Note: All estimates were originally made in pounds and were converted to dollars based on £1 = $2.033. Generic questionnaire Waiting time, days −7.22 (−7.89 to −6.61) −3.35 (−4.49 to −2.24) −3.35 (−4.19 to −2.54) −18.48 (−20.96 to −16.39) Doctor knows you well 12.18 (10.15 to 14.29) 19.11 (15.39 to 23.10) 9.60 (6.95 to 12.34) 11.47 (6.59 to 16.79) You get a choice of appointment times 6.71 (4.72 to 8.72) 1.99 (−1.50 to 5.59) 5.49 (2.85 to 8.19) 12.04 (7.20 to 17.32) Doctor is warm and friendly 8.50 (6.55 to 10.49) 9.17 (5.75 to 12.71) 8.58 (5.98 to 11.22) 6.14 (1.50 to 10.88) Doctor gives you a thorough physical examination 40.87 (38.43 to 43.45) 47.88 (43.39 to 52.88) 27.39 (24.62 to 30.29) 59.76 (52.62 to 68.38) Patient-centered care questionnaire Waiting time, days −6.93 (−7.54 to −6.34) −3.07 (−4.11 to −2.03) −3.25 (−4.09 to −2.40) −16.16 (−17.99 to −14.58) Doctor knows you well 17.77 (15.82 to 19.80) 17.81 (14.54 to 21.23) 16.86 (14.07 to 19.74) 21.21 (16.83 to 26.00) Doctor is interested in your ideas 14.82 (12.93 to 16.77) 16.35 (13.13 to 19.76) 14.31 (11.59 to 17.14) 15.86 (11.81 to 20.15) Doctor asks about your social and emotional well-being 12.61 (10.69 to 14.54) 23.54 (20.19 to 27.08) 9.17 (6.42 to 11.93) 5.33 (1.30 to 9.37) Doctor involves you in decision making 12.06 (10.19 to 13.99) 15.31 (12.12 to 18.68) 10.55 (7.87 to 13.30) 10.98 (6.97 to 15.21)
Supplemental Appendixes
Supplemental Appendix 1. Random Effects Probit Models. Supplemental Appendix 2. Models With Statistical Interaction Terms. Supplemental Appendix 3. Probit Models Weighted for Non-Response.
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file, 1 page, 123 KB
- Supplemental data: Appendix 2 - PDF file, 3 pages, 131 KB
- Supplemental data: Appendix 3 - PDF file, 2 pages, 110 KB
The Article in Brief
What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients' Priorities
Sudeh Cheraghi-Sohi, BSc, and colleagues
Background What do patients consider important when they visit the doctor? This study assesses patient priorities in the doctor visit.
What This Study Found Although communication is important to patients, they place higher priority on technical care and continuity of care (an ongoing relationship with a clinician). Patients value the thoroughness of the primary care visit most highly, followed by seeing a doctor who knows them well, seeing a doctor with a warm and friendly manner, less waiting time for an appointment, and flexibility in selecting appointment times.
Implications
- In order to make decisions about their medical care, patients need information about both technical and relationship aspects of care. Little is known, however, about how patients assess technical care.
- The results of this study can inform discussions of health care policy and payment.
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