Patient Preference and Adherence (Aug 2022)

Preference to Family Doctor Contracted Service of Patients with Chronic Disease in Urban China: A Discrete Choice Experiment

  • Wang H,
  • Sun H,
  • Jin C,
  • Wang M,
  • Luo Y,
  • Song W,
  • Wang H

Journal volume & issue
Vol. Volume 16
pp. 2103 – 2114

Abstract

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Haode Wang,1 Hui Sun,1,2 Chunlin Jin,1 Meifeng Wang,1 Yashuang Luo,1 Wenqian Song,3 Haiyin Wang1 1Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China; 2Key Laboratory of Health Technology Assessment, National Health Commission; School of Public Health, Fudan University, Shanghai, People’s Republic of China; 3Shanghai Overseas Rescue and Aid Service Center, Shanghai, People’s Republic of ChinaCorrespondence: Haiyin Wang, Shanghai Health Development Research Center, Minhang District, No. 181 Xinbei Road, Shanghai, 201199, People’s Republic of China, Tel +86- 18917769216, Email [email protected]: Shanghai is one of the pioneers proposing family doctor contract service (FDCS). However, there is no quantitative research focusing on the Shanghai experience from a demand-side perspective. This study investigated Shanghai chronic patients’ relative preferences for FDCS using a discrete choice experiment method.Methods: A face-to-face discrete choice experiment (DCE) was performed to elicit the preference with 300 samples. Attributes and levels were extracted from the literature review and focus group consultation with patients. Seven attributes, follow-up frequency, medicine accessibility, family doctor competency, health management, referral convenience, appointment flexibility, and shared decision-making, were decided. Three levels were attached to each attribute. A mixed logit model was used to evaluate the multiple-choice data.Results: A total of 248 patients completed the survey. Patient valued FDCS medicine accessibility (β=0.57, P < 0.05), and high family doctor competency (β= 0.43, P < 0.05), regular health management activities (β=0.36, P < 0.05), high follow-up frequency (β=0.31, P < 0.05) the most. The good doctor-patient shared decision-making atmosphere (β=0.12, P < 0.05), high referral convenience (β=0.06, P < 0.05) and high appointment flexibility (β=0.04, P < 0.05) are valued as less important. No significant preference heterogeneity was identified for patients with different sociodemographic characteristics. Respondents reported other FDCS needs, including online health consultation, specialist services in local institutes, higher reimbursement rates, free rehabilitation guidance for the disabled and personal health management.Conclusion: This research is the first discrete choice experiment FDCS preference research targeting on Chinese urban population. The results suggested that to increase the quality of FDCS, policy-makers should prioritize follow-up frequency, medicine accessibility, family doctor competency and health management. The service package should consider a higher reimbursement rate and rehabilitation guidance for the disabled if extra health-care resources available. Future FDCS policy should consider stated societal preference and be congruent with it.Keywords: primary care, family doctor contract services, urban resident preferences, discrete choice experiment

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