title: The introduction of integrated out-of-hours arrangements in England: a discrete choice experiment of public preferences for alternative models of care.
abstract: OBJECTIVE
  To establish which generic attributes of general practice out-of-hours health services are important to the public.
  
  
  METHODS
  A discrete choice experiment postal survey conducted in three English general practitioner (GP) co-operatives. A total of 871 individuals aged 20-70 years registered with a GP. Outcomes were preferences for, and trade-offs between: time to making initial contact, time waiting for advice/treatment, informed of expected waiting time, type of contact, professional providing advice, chance contact relieves anxiety, and utility estimates for valuing current models of care.
  
  
  RESULTS
  Response rate was 37%. Respondents valued out-of-hours contact for services for reducing anxiety but this was not the only attribute of importance. They had preferences for the way in which services were organized and valued information about expected waiting time, supporting findings from elsewhere. Participants were most willing to make trade-offs between waiting time and professional person. Of the predicted utility for three models of care utility was higher for fully integrated call management.
  
  
  CONCLUSIONS
  Greater utility might be achieved if existing services are re-configured more in line with the government's fully integrated call management model. Because the attributes were described in generic terms, the findings can be applied more generally to the plethora of models that exist (and many that might exist in the future). The approach used is important for achieving greater public involvement in how health services develop. Few experiments have elicited public preferences for health services in the UK to date. This study showed valid preferences were expressed but there were problems obtaining representative views from the public.
authors.affiliation: School of Nursing and Midwifery, University of Southampton, Southampton, UK. kareng@soton.ac.uk
authors.forename: Karen
authors.initials: K
authors.lastname: Gerard
authors.forename: Val
authors.initials: V
authors.lastname: Lattimer
authors.forename: Heidi
authors.initials: H
authors.lastname: Surridge
authors.forename: Steve
authors.initials: S
authors.lastname: George
authors.forename: Joanne
authors.initials: J
authors.lastname: Turnbull
authors.forename: Abigail
authors.initials: A
authors.lastname: Burgess
authors.forename: Judith
authors.initials: J
authors.lastname: Lathlean
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D003258:Consumer Behavior; D004739:England; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D013222:State Medicine / Q000458:organization & administration