What patients want from primary care consultations: a discrete choice experiment to identify patients' priorities.
OBJECTIVE
The consultation is fundamental to the delivery of primary care, but different ways of organizing consultations may lead to different patient experiences in terms of access, continuity, technical quality of care, and communication. Patients' priorities for these different issues need to be understood, but the optimal methods for assessing priorities are unclear. This study used a discrete choice experiment to assess patients' priorities.


METHODS
We surveyed patients from 6 family practices in England. The patients chose between primary care consultations differing in attributes such as ease of access (wait for an appointment), choice (flexibility of appointment times), continuity (physician's knowledge of the patient), technical quality (thoroughness of physical examination), and multiple aspects of patient-centered care (interest in patient's ideas, inquiry about patient's social and emotional well-being, and involvement of patient in decision making). We used probit models to assess the relative priority patients placed on different attributes and to estimate how much they were willing to pay for them.


RESULTS
Analyses were based on responses from 1,193 patients (a 53% response rate). Overall, patients were willing to pay the most for a thorough physical examination ($40.87). The next most valued attributes of care were seeing a physician who knew them well ($12.18), seeing a physician with a friendly manner ($8.50), having a reduction in waiting time of 1 day ($7.22), and having flexibility of appointment times ($6.71). Patients placed similar value on the different aspects of patient-centered care ($12.06-$14.82). Responses were influenced by the scenario in which the decision was made (minor physical problem vs urgent physical problem vs ambiguous physical or psychological problem) and by patients' demographic characteristics.


CONCLUSIONS
Although patient-centered care is important to patients, they may place higher priority on the technical quality of care and continuity of care. Discrete choice experiments may be a useful method for assessing patients' priorities in health care.
Cheraghi-Sohi
Sudeh
S
National Primary Care Research and Development Centre (NPCRDC), University of Manchester, Manchester, United Kingdom.
Hole
Arne Risa
AR
Mead
Nicola
N
McDonald
Ruth
R
Whalley
Diane
D
Bower
Peter
P
Roland
Martin
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D002755:Choice Behavior; D004739:England; D005194:Family Practice; D005102:Health Expenditures; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011787:Quality of Health Care