Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses

Arif Ahmed; Jack E. Fincham

doi:10.1370/afm.1052

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Table 1.

Preamble Statement and Attributes Used in the Discrete Choice Experiment

Preamble statement
For the next set of items, I would like you to place yourself in the following situation [symptom scenario]…, and you have decided to seek medical care. The type of care that you can receive is either from a physician at a private practice OR from a nurse practitioner at a clinic within a supermarket, discount store, or chain pharmacy. You could either obtain these services on the same day or wait 1 day or more. The price you would pay would be either $59 or $75. Now I am going to read you hypothetical situations involving where you might receive care, whether care was received on the same day or 1 day later, and whether the cost of care was $59 or $75, and I would like you to tell me whether you would use the option.
Attributes	Level
Symptom scenarios	Influenza: You have high fever, dry cough, and a sore throat. Your nose feels stuffy, you feel extremely tired, and you have muscle pain all over your body. The symptoms started to develop 4 days ago, and seem to have worsened this morning   Urinary tract infection: Since yesterday morning you have been having frequent strong urges to urinate that cannot be delayed. Despite the strong urge, very little urine is released each time, and you feel a sharp pain or burning sensation in the bladder or urethra area during urination. This morning you noticed that the urine is tinged with blood
Care setting-clinician combinations	Physician at a private practice   Nurse practitioner at a clinic within a supermarket, discount store, or chain pharmacy
Price	$59   $75
Appointment wait time	Same day   Wait 1 day or more

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Table 2.

Demographic Characteristics of the Respondents

Characteristic	Value
GED = general equivalency diploma; MSA = metropolitan statistical area.
Age, mean (SD), years	49.47 (15.38)
Race, n (%)
White	357 (73.6)
Black	108 (22.3)
Asian	3 (0.6)
Hispanic	6 (1.2)
Multiracial	11 (2.3)
Sex, n (%)
Male	158 (32.0)
Female	335 (68.0)
Education, n (%)
Less than 12 years	24 (4.9)
High school diploma/GED	112 (22.9)
Some college/technical school/no degree	114 (23.3)
2-year college	49 (10.0)
Bachelor’s degree	143 (29.2)
Advanced or professional degree	47 (9.6)
Household income, n (%)
Less than $25,000	50 (13.7)
$25,000-$49,999	85 (23.3)
$50,000-$74,999	84 (23.0)
$75,000 or more	146 (40.0)
Marital status, n (%)
Married	309 (63.4)
Divorced	50 (10.3)
Separated	6 (1.2)
Widowed	51 (10.5)
Never married	71 (14.6)
Home ownership, n (%)
Rent	64 (13.4)
Own	415 (86.6)
Lives in an MSA, n (%)
Yes	383 (77.7)
No	110 (22.3)

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Table 3.

Results of the Random-Effects Logistic Regression

Variable (Reference Category^a)	β	SE	z	P >\|z\|	95% CI	Odds Ratio
CI=confidence interval; NS = not significant; SE=standard error.
ρ =0.314.
Likelihood ratio test of ρ =0: χ²=788.13; P <.001.
^a Variables listed with reference categories were entered in the regression as dichotomous variables (presence or absence of the reference characteristic).
Symptom scenario (urinary tract Infection)	−0.14877	0.05635	−2.64	.008	−0.25920 to −0.03833	0.882
Appointment wait period (1 day or more)	−2.78922	0.07882	−35.39	<.001	−2.94371 to −2.63474	0.107
Provider care setting (physician at private office)	1.06723	0.07365	14.49	<.001	0.92288 to 1.21158	2.365
Fee	−0.03396	0.00353	−9.62	<.001	−0.04088 to −0.02705	–
Age	−0.00682	0.00372	−1.83	.067	−0.01411 to 0.00047	–
Race (white)	0.03424	0.05786	0.59	.554	−0.07918 to 0.14765	NS
Sex (male)	−0.04879	0.12731	−0.38	.702	−0.29831 to 0.20073	NS
Education (high school or less)	−0.02515	0.03632	−0.69	.489	−0.09633 to 0.04603	NS
Income	0.00597	0.02585	0.23	.817	−0.04469 to 0.05664	–
Constant	5.69811	0.49620	11.48	<.001	4.72559 to 6.67064	–

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Table 4.

Calculations of Estimates for Willingness To Pay (WTP)

Variable/Attribute (Choice)	Coefficient β	WTP Calculation β_j ÷ (−β_price)	WTP $
Fee (price)	−0.033965	–	–
Clinician-care setting (receive care from physician at private office)	1.067227	1.067227/0.033965	31.42
Appointment wait period (wait 1 day or more)	−2.789223	−2.789223/0.033965	−82.12
Constant (seek medical care)	5.698113	5.698113 / 0.033965	167.77

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The Article in Brief

Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses

Arif Ahmed , and colleagues

Background Retail clinics are a new and fast-growing health care option in the US, offering cheaper and convenient alternatives to doctors' offices for minor illness and wellness care. This study examines the effects of cost of care and appointment wait time on patients' decisions about whether to seek care at retail clinics or doctors' offices.

What This Study Found Time and cost savings offered by retail clinics are attractive to patients, and patients are likely to visit them for care of minor illnesses if there are sufficient cost savings. Although patients prefer receiving care from a doctor at a private office, they will consider other options in order to save a sufficient amount of money. Appointment wait time is the most important factor in patients� care-seeking decisions.

Implications

Because of the importance that patients place on appointment wait time, the authors suggest that primary care practices consider patient convenience features such as same-day scheduling, walk-in clinics and extended hours.