Abstract Objectives : To quantify patients' preferences for new pharmacist independent prescribing services in general practice for managing common existing long-term conditions compared with usual ...medical prescribing. Methods A discrete choice experiment cross-sectional survey was conducted in five general practices in England (October–November 2009). Four service attributes reported on the length of consultation and aspects of patient-professional interaction. A choice between three alternatives—novel pharmacist independent prescribing service (“prescribing pharmacist”), “own (family) doctor” service, and “available (family) doctor” service—was presented. Alternative regression models were compared according to their goodness of fit, and the preferred one was used to inform policy analysis. Results A total of 451 patients completed questionnaires. Respondents preferred a “pharmacist” or “own doctor” compared with “available doctor,” with a larger value given to own doctor. All attributes on patient-professional interaction were important in choosing how to manage diagnosed hypertension, while the “length of consultation” ( P = 0.42) did not have any impact. The impact of introducing a pharmacist prescribing service into a general practice setting was estimated from these findings. Patients' preferences suggested that about 16% of consultations with a patient's own doctor can be switched to a prescribing pharmacist instead. Although there is a stronger preference for seeing own doctor, alternative combinations of attribute levels can be used to compensate and reconfigure a more preferred prescribing pharmacist service. Conclusions The pharmacist service is valued by patients as an alternative to doctor prescribing in primary care and therefore represents an acceptable form of service delivery when informing policy.
This paper presents an overview of Gavin Mooney's contributions to broadening the evaluative space in health economics. It outlines how Mooney's ideas have encouraged many, including ourselves, to ...expand the conventional QALYs/health gain approach and look more broadly at what it is that is of value from health services. We reflect on Mooney's contributions to debates around cost-effectiveness analysis, Quality Adjusted Life Years (QALYs) and cost-utility analysis as well as his contribution to the development and application of contingent valuation and discrete choice experiments in health economics. We conclude by suggesting important avenues for future research to take forward Mooney's work.
There has been growing interest in discrete choice experiments (DCEs) in health economics over the last few years. This paper identifies and describes applications conducted during 1990-2000. From ...this basis some important areas for future research are reflected upon. These include: having a better understanding of how respondents interpret price, risk and time attributes; strengthening designs and analysis; investigating decision making heuristics employed when completing DCEs, and the extent these are related to the complexity of the task; external validity, reliability and generalisability. Collaborative work with statistical design experts, psychologists, sociologists and qualitative researchers will prove useful when investigating these issues. It is also critical to link, more generally, the research agenda to work being carried out in marketing, transport and environmental economics and health economics benefit assessment.
Background
Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non‐medical prescribing was introduced to improve patient access to medicines, make better use ...of different health practitioners' skills and increase patient choice. There is little evidence about value‐based patient preferences for ‘prescribing nurse’ in a general practice setting.
Objective
To quantify value‐based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness.
Design
Discrete choice experiment patient survey.
Setting and participants
Five general practices in England with non‐medical prescribing services, questionnaires completed by 451 patients.
Main outcome measure
Stated choice of consultation.
Main results
There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient‐focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional's attention to Patients' views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference.
Discussion and conclusion
Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study's limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations.
Highlights • We examine societal preferences for cannabis policies. • Policy attributes which varied included legal status, health harms, criminal justice service costs, rates of cannabis use and ...purchase location. • We find a strong general preference for either civil penalties or legalisation compared to cannabis cautioning. • There is a strong dislike of criminalising possession. • Demographics and beliefs impact significantly on preferences.
In many countries a high proportion of births begin as induced labours. Induction can be lengthy if cervical priming is required prior to induction. This usually occurs as an inpatient, however, an ...alternative is to allow women to go home after satisfactory fetal monitoring. The aim of this study was to assess the preferences of women for cervical priming for induction of labour in an outpatient or inpatient setting.
A discrete choice experiment (DCE) was conducted alongside a randomised trial of inpatient and outpatient cervical priming (the OPRA trial) in two maternity hospitals in South Australia. 362 participants were included, and women's preferences for cervical priming for induction of labour were assessed.
Women were willing to accept an extra 1.4 trips to hospital (2.4 trips total) and a total travel time of 73.3 minutes to be able to return to their own home while waiting for the priming to work. For enhanced inpatient services, women were willing to accept a total travel time of 54.7 minutes to have a private room with private bathroom while waiting for the priming to work. The overall benefit score for outpatient priming was 3.63, 3.59 for enhanced inpatient care and 2.89 for basic inpatient care, suggesting slightly greater preferences for outpatient priming. Preferences for outpatient priming increased when women could return to their own home (compared to other offsite accommodation), and decreased with more trips to hospital and longer travel time.
Our results suggest that outpatient priming was slightly more preferred than either enhanced inpatient priming or basic care; these results should be confirmed in different clinical settings. There may be merit in providing women information about both options in the future, as preferences varied according to the characteristics of the services on offer and the sociodemographic background of the woman.
Objectives
To determine the relative importance of factors that influence patient choice
in the booking of general practice appointments for two health problems.
Methods
Two discrete choice ...experiments incorporated into a survey of general
practice patients and qualitative methods to support survey development.
Results
An overall response of 94% (1052/1123) was achieved. Factors influencing the
average respondent's choice of appointment, in order of importance, were:
seeing a doctor of choice; booking at a convenient time of day; seeing any
available doctor; and having an appointment sooner rather than later (acute,
low worry condition). This finding was the same for an ongoing, high worry
condition but in addition the duration of the appointment was also of
(small) value. Patients traded off speed of access for more convenient
appointment times (a willingness to wait an extra 2.5-3 days longer to get a
convenient time slot for an acute low worry/ongoing, high worry condition,
respectively). However, contrary to expectation, patients were willing to
trade off speed of access for continuity of care (e.g. willingness to wait
five days longer to see the doctor of their choice for an acute, low worry
condition). Preferences varied by a person's gender, work and carer
status.
Conclusions
Patients hold strong preferences for the way general practice appointment
systems are managed. Contrary to current policy on improving access to
primary care patients value a more complex mix of factors than fast access
at all costs. It is important that policy-makers and practices take note of
these preferences.
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