title: Preferences for aspects of a dermatology consultation.
abstract: BACKGROUND
  General practitioners with special interests (GPSIs) are increasingly being used to provide dermatology services in the U.K. Little is known about U.K. dermatology patient attitudes to proposed variations in secondary care service delivery or the values they attach to aspects of the care they receive.
  
  
  OBJECTIVE
  To quantify preferences for different attributes of care within dermatology secondary care services.
  
  
  METHODS
  Attributes of care that are important to dermatology patients were derived using in-depth qualitative interviews with 19 patients at different points in the care pathway. A discrete choice experiment using 'best-worst scaling' was sent by post to 119 patients referred to secondary care dermatology services and suitable for GPSI care who had agreed to participate in research.
  
  
  RESULTS
  Four attributes were derived from the qualitative work: waiting, expertise, thorough care and convenience. For the discrete choice experiment, 99 patients returned questionnaires, 93 of which contained sufficient data for analysis. All attributes were found to be quantitatively important. The attribute of greatest importance was expertise of the doctor, while waiting time was of least importance. Respondents were willing to wait longer than the current 3 months maximum to receive care that was thorough, 2.1 months to see a team led by an expert and 1.3 months to attend a consultation that is easy to get to.
  
  
  CONCLUSIONS
  Although the need to reduce outpatient waiting times is a key policy driver behind the expansion of GPSI services, this does not appear to be the most important issue for patients. The thoroughness with which the consultation is provided and the expertise of the clinician seen are higher priorities.
authors.affiliation: Health Economics Facility, Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT,UK. j.coast@bham.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Coast
authors.forename: C
authors.initials: C
authors.lastname: Salisbury
authors.forename: D
authors.initials: D
authors.lastname: de Berker
authors.forename: A
authors.initials: A
authors.lastname: Noble
authors.forename: S
authors.initials: S
authors.lastname: Horrocks
authors.forename: T J
authors.initials: TJ
authors.lastname: Peters
authors.forename: T N
authors.initials: TN
authors.lastname: Flynn
mesh_terms: D001294:Attitude to Health; D002755:Choice Behavior; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D003880:Dermatology / Q000458:organization & administration* / Q000592:standards; D004739:England; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D014850:Waiting Lists