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Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment

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Abstract

Objectives

Increased demand for gastroenterology services has resulted in growing waitlists, with patients at risk of exceeding clinically recommended wait-times. Given limited healthcare resources, expanded scope models of care are an option to help address this demand, but little is known about patient preferences for these models of care.

Methods

Low-risk gastroenterology patients (n = 1198) referred to an outpatient tertiary service in Australia over a 2-year period were invited to participate in an unlabelled discrete choice experiment with seven attributes: primary healthcare professional, wait-time, continuity of care, consultation length, manner and communication skills, reassurance, and cost. These were developed using qualitative research, literature review, and stakeholders’ experiences. A d-efficient fractional design was used to construct four blocks of 12 choice sets, with two alternatives. A 13th choice set was included as a data and quality check. Latent class and mixed logit regression were used for analysis. The resulting preference parameters for individual attributes were then used to calculate willingness to pay and willingness to wait.

Results

Overall, the model based on the 347 respondents suggested no strong preference for professional background. All other attributes were statistically significant predictors of preference (p < 0.001), with respondents willing to make significant trade-offs (time and cost) before accepting deterioration in attributes. There was strong emphasis on manner and communication skills, with a clinician who listens and provides good explanations overwhelmingly the most important attribute. Latent class analysis identified two patient segments who differed in their preference for the primary treating healthcare professional (doctor or dietitian) based on exposure to either traditional medical or non-medical professional role substitution model.

Conclusions

Patients have strong but varied preferences for gastroenterology services based on whether they have been exposed to expanded scope models of care. Design and implementation of new models of care need to consider strategies to overcome any perceived loss in utility or deterioration in healthcare quality for those unfamiliar with professional role substitution.

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Acknowledgements

The authors acknowledge the Gold Coast Hospital and Health Service gastroenterology and nutrition departments. A special thanks to the participants who gave up their time to share their experiences and perceptions for the future benefit of others and the healthcare system. We would like to thank all the patients and practice staff who contributed to this study, and the members of the project Advisory Group.

Author information

Authors and Affiliations

  1. Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia

    Rumbidzai N. Mutsekwa & Rebecca L. Angus

  2. Gold Coast Hospital and Health Service, Allied Health Research Team, Southport, QLD, Australia

    Rumbidzai N. Mutsekwa

  3. Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia

    Rumbidzai N. Mutsekwa, Katrina L. Campbell & Joshua M. Byrnes

  4. Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia

    Katrina L. Campbell & Joshua M. Byrnes

  5. Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia

    Katrina L. Campbell

  6. Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport, Southport, QLD, Australia

    Russell Canavan

  7. Centre for Health Economics Research, University of Technology Sydney, Sydney, NSW, Australia

    Brendan Mulhern

  8. School of Allied-health Sciences and Social Work, Griffith University, Southport, QLD, Australia

    Rebecca L. Angus

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  1. Rumbidzai N. Mutsekwa
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Corresponding author

Correspondence to Rumbidzai N. Mutsekwa.

Ethics declarations

Funding

This work was supported by the Gold Coast Hospital and Health Service Collaborative Research Grant [Grant number RGS20190041].

Competing interests

None declared.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Gold Coast Hospital and Health Service (HREC/2020/QGC/62104) and Griffith University (GU Ref No: 2020/876) Human Research Ethics Committees.

Consent for participate

Completion of the questionnaire was taken as implied consent to participate in the survey.

Data sharing statement

Due to our institutional restrictions, there are no individual participant data that can be shared. However, further information can be obtained from the corresponding author.

Code availability

Not applicable.

Transparency declaration

The lead author affirms that this article is an honest, accurate and transparent account of the study being reported. The reporting of this work is compliant with International Society for Pharmacoeconomics and Outcomes Research guidelines which were followed for the design, execution, analysis, and interpretations of the DCE. The lead author affirms that no important aspects of the study have been omitted and that there were no discrepancies from the study as planned.

Author Contributions

RM, JB, KC, BM, RC and RA contributed to the conception and design of the study. RM led the data collection and analysis and wrote the initial draft of the manuscript. RM, JB, KC, BM, RC and RA interpreted results, critically revised the manuscript, and approved the final version.

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Mutsekwa, R.N., Campbell, K.L., Canavan, R. et al. Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment. Patient 16, 165–177 (2023). https://doi.org/10.1007/s40271-022-00609-4

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  • DOI: https://doi.org/10.1007/s40271-022-00609-4

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