What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients' Priorities

Abstract

PURPOSEThe consultation is fundamental to the delivery of primary care, but different ways of organizing consultations may lead to different patient experiences in terms of access, continuity, technical quality of care, and communication. Patients' priorities for these different issues need to be understood, but the optimal methods for assessing priorities are unclear. This study used a discrete choice experiment to assess patients' priorities. METHODSWe surveyed patients from 6 family practices in England. The patients chose between primary care consultations differing in attributes such as ease of access (wait for an appointment), choice (fl exibility of appointment times), continuity (physician's knowledge of the patient), technical quality (thoroughness of physical examination), and multiple aspects of patient-centered care (interest in patient's ideas, inquiry about patient's social and emotional well-being, and involvement of patient in decision making). We used probit models to assess the relative priority patients placed on different attributes and to estimate how much they were willing to pay for them. RESULTSAnalyses were based on responses from 1,193 patients (a 53% response rate). Overall, patients were willing to pay the most for a thorough physical examination ($40.87). The next most valued attributes of care were seeing a physician who knew them well ($12.18), seeing a physician with a friendly manner ($8.50), having a reduction in waiting time of 1 day ($7.22), and having fl exibility of appointment times ($6.71). Patients placed similar value on the different aspects of patient-centered care ($12.06-$14.82). Responses were infl uenced by the scenario in which the decision was made (minor physical problem vs urgent physical problem vs ambiguous physical or psychological problem) and by patients' demographic characteristics.CONCLUSIONS Although patient-centered care is important to patients, they may place higher priority on the technical quality of care and continuity of care. Discrete choice experiments may be a useful method for assessing patients' priorities in health care.

Choosing a Doctor: Does Presentation Format Affect the Way Consumers Use Health Care Performance Information?

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Accessing primary care: a simulated patient study

“…It has also been identified as 'relational'; one of three domains of continuity, the others being 'management' and 'informational'. 11,12 In this study, the GP Patient Survey measure of relational continuity of care was neither related to the three measures of practice telephonesystem efficiency, nor to a proxy measure of receptionist efficiency: namely, the time taken to successfully resolve the appointment request. However, relational continuity was related to appointment availability; practices characterised by the GP Patient Survey as providing less continuity of care experienced increased delays when an appointment with a specific doctor was requested.…”

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

“…It also suggests that continuity of care is desirable so that GP and patient have the opportunity to understand the complexity of the problem over a series of consultations. Continuity of care is highly valued by patients 23 and in the US has been shown to be associated with the confidence felt by primary care physicians in managing MUS. 24 Current policy within UK primary care values access before continuity, meaning that it is now more difficult for people with complex chronic problems to achieve continuity of care with an individual provider.…”