Reviewing emergency care systems 2: measuring patient preferences using a discrete choice experiment.
OBJECTIVE
To investigate patients' strength of preferences for attributes associated with modernising delivery of out of hours emergency care services in Nottingham.


METHODS
A discrete choice experiment was applied to quantify preferences for key attributes of out of hours emergency care. The attributes reflected the findings of previous research, current policy initiatives, and discussions with local key stakeholders. A self complete questionnaire was administered to NHS Direct callers and adults attending accident and emergency, GP services and NHS walk-in centre. Regression analysis was used to estimate the relative importance of the different attributes.


RESULTS
Response was 74% (n = 457) although 61% (n = 378) were useable. All attributes were statistically significant. Being consulted by a doctor was the most important attribute. This was followed by being consulted by a nurse, being kept informed about waiting time, and quality of the consultation. Respondents were prepared to wait an extra 2 hours 20 minutes to be consulted by a doctor. There were no measurable preference differences between patients surveyed at different NHS entry points. Younger respondents preferred single telephone call access to health care out of hours. Although having services provided close to home and making contact in person were generally preferred, they were less important than others, suggesting that a range of service locations may be acceptable to patients.


CONCLUSIONS
This study showed that local solutions for reforming emergency out of hours care should take account of the strength of patient preferences. The method was acceptable and the results have directly informed the development of a local service framework for emergency care.
Gerard
K
K
Health Care Research Unit, School of Medicine, University of Southampton and Health Economics Research Centre, University of Oxford, UK. kareng@soton.ac.uk <kareng@soton.ac.uk>
Lattimer
V
V
Turnbull
J
J
Smith
H
H
George
S
S
Brailsford
S
S
Maslin-Prothero
S
S
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000367:Age Factors; D000368:Aged; D002755:Choice Behavior; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods; D004739:England; D005260:Female; D006282:Health Personnel; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D013222:State Medicine; D011795:Surveys and Questionnaires; D013997:Time Factors