A qualitative investigation into the results of a discrete choice experiment and the impact of COVID-19 on patient preferences for virtual consultations

Abstract

Objectives To conduct a qualitative investigation on a subset of participants from a previously completed Discrete Choice Experiment (DCE) to understand why factors identified from the DCE are important, how they influenced preference for virtual consultations (VC) and how COVID-19 has influenced preference for VC. Methods A quota sample was recruited from participants who participated in our DCE. We specifically targeted participants who were strongly in favour of face-to-face consultations (F2F - defined as choosing all or mostly F2F in the DCE) or strongly in favour of virtual consultations (VC - defined as choosing all or mostly VC consultations in the DCE) to elicit a range of views. Interviews were conducted via telephone or videoconference, audio recorded, transcribed verbatim and uploaded into NVIVO software. A directed content analysis of transcripts was undertaken in accordance with a coding framework based on the results of the DCE and the impact of COVID-19 on preference. Results Eight F2F and 5 VC participants were included. Shorter appointments were less ‘worth’ travelling in for than a longer appointment and rush hour travel had an effect on whether travelling was acceptable, particularly when patients experienced pain as a result of extended journeys. Socioeconomic factors such as cost of travel, paid time off work, access to equipment and support in its use was important. Physical examinations were preferable in the clinic whereas talking therapies were acceptable over VC. Several participants commented on how VC interferes with the patient-clinician relationship. VC during COVID-19 has provided patients with the opportunity to access their care virtually without the need for travel. For some, this was extremely positive. Conclusions This study investigated the results of a previously completed DCE and the impact of COVID-19 on patient preferences for VC. Theoretically informative insights were gained to explain the results of the DCE. The use of VC during the COVID-19 pandemic provided opportunities to access care without the need for face-to-face social interactions. Many felt that VC would become more commonplace after the pandemic, whereas others were keen to return to F2F consultations as much as possible. This qualitative study provides additional context to the results of a previously completed DCE.

The patient acceptability of a remotely delivered pain management programme for people with persistent musculoskeletal pain: A qualitative evaluation

“…The insights we gained in this evaluation are in keeping with our previously published research, finding that virtual care is more viable for patients when they have competing demands 24 (such as requiring childcare) and preferred by patients when they have high travel costs, experience difficulty with travel, 21 have adequate access to technology 25 and do not require ‘hands-on’ care. 21 Clinicians could consider these factors, along with the patient’s skills using technology and potential risk of harm, when assessing patients for remotely delivered programmes and when discussing treatment options with patients to ensure patient-centred care. The recommendations for practice, based on the empirical data from this evaluation, have been organised in relation to the TFA and are presented in Table 2.…”

Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID‐19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting

“…This present research study builds on the previous insights gained from earlier phases of the CONNECT Project 11,15–17 to understand how patient preferences for VC have changed during the accelerated implementation of VC during the COVID‐19 pandemic.…”

“…1(b): Codes were characterized in light of the previously gained knowledge arising from the CONNECT Project in Phase I, 11 Phase II 15 and Phase III. 16 , 17 The purpose of the characterisation was to abductively extend insights from the previous research to develop new insights into the development and organisation of patient preferences.…”

“…Data analysis followed the principles of abduction as set out by Tavory and Timmermans, 27 11 Phase II 15 and Phase III. 16,17 The purpose of the characterisation was to abductively extend insights from the previous research to develop new insights into the development and organisation of patient preferences. This study presents significant new data and performs an integrative analysis of this in relation to old data.…”

“… 16 COVID‐19 appeared to influence preferences in favour of a VC but we cannot be sure whether this shift is permanent. 17 This paper brings together these previous studies to develop a model of preference formation through an empirical investigation into the experiences of VC implementation due to COVID‐19.…”