Preference for Community Health Services of Patients with Multimorbidity

Abstract

Background As aging process continues to accelerate in China, multimorbidity have become a major public problem that threatens the health of the entire population. In the current context of "Healthy China 2030", the health management of patients with multimorbidity needs to be urgently addressed. Objective To understand the preferences influencing the choice of community health services for patients with multimorbidity, explore the willingness to pay (WTP) of patients, so as to provide recommendations for improvements to the existing community health service system for chronic diseases. Methods Patients with multimorbidity were randomly selected from eight community health service centers in Chengdu during the period from May to August 2022 as survey subjects. General patient data and preferences related to discrete choice experiments were collected through on-site questionnaire surveys. Based on different types of comorbidities, patients with type 2 diabetes combined with hypertension, hypertension combined with coronary heart disease, type 2 diabetes combined with hypertension and coronary heart disease were categorized into ClassⅠ, ClassⅡ, and ClassⅢ. Regression analysis was conducted using mixed Logit model to analyze the preferences of multimorbidity patients for community health services, and to quantitatively analyze their WTP for community health services. Result A total of 360 questionnaires were distributed and 296 valid questionnaires were recovered, with a valid recovery rate of 82.7%. ClassⅠpatients (β=3.260, 95%CI=2.610 to 3.910), ClassⅡpatients (β=3.697, 95%CI=2.612 to 4.781), and ClassⅢpatients (β=3.220, 95%CI=2.271 to 4.169) expressed the strongest preference for services with high accessibility to drugs, followed by appointment referral services and traditional Chinese medicine (TCM) services. Regarding physician types and prescription service duration, both ClassⅠpatients (β=0.971, 95%CI=0.585 to 1.357) and ClassⅡpatients (β=0.686, 95%CI=0.176 to 1.197) preferred services with extended prescription services, while ClassⅢpatients (β=0.804, 95%CI=0.196 to 1.413) preferred services provided by general practitioners (β=0.804, 95%CI=0.196 to 1.413). ClassⅠpatients (β=-0.049, 95%CI=-0.057 to -0.041), ClassⅡpatients (β=-0.040, 95%CI=-0.051 to -0.029), and ClassⅢpatients (β=-0.037, 95%CI=-0.048 to -0.027) preferred services with lower out-of-pocket expenses. The results of the regression analysis of WTP for patients with different chronic comorbidity types showed that the WTP of all 3 types of patients was related to their level of preference for each attribute, with ClassⅠ, ClassⅡ, and ClassⅢpatients all had the highest WTP for a high level of drug accessibility, which were RMB 66.77/month, RMB 91.97/month, and RMB 85.95/month, respectively. Conclusion Patients with multimorbidity exhibit significant preferences for six attributes considered in this study (physician type, TCM service, prescription service duration, drug accessibility, appointment referral, and monthly out-of-pocket costs). Drug accessibility is the most important attribute influencing multimorbidity patients' health service preferences. It is recommended to target patients' specific needs accurately, improve appointment referral services, establish standards for the management of chronic diseases in the community, and accelerate the integration of TCM into the prevention and treatment of chronic diseases in the community.

Keywords

• multimorbidity|community health services|preference|discrete selection experiment