Background: Specialized community pharmacy services, involving the provision of disease state management and care by pharmacists, have been developed and trialled and have demonstrated very good health outcomes. Most of these services have been developed from a healthcare professional perspective. However, for the future uptake and long-term sustainability of these services as well as for better and sustained health outcomes for patients, it is vital to gain an understanding of patients’ preferences. We can then structure healthcare services to match these preferences and needs rather than around clinical viewpoints alone.
Objective: The aim of this study was to elicit patient preferences for pharmacy-based specialized asthma services using a discrete choice experiment and to explore the value/importance that patients place on the different attributes of the asthma service. The existence of preference heterogeneity in the population was also investigated.
Methods: The study was conducted with asthma patients who had recently experienced a specialized asthma management service at their pharmacy in New South Wales, Australia. Pharmacists delivering the asthma service mailed out the discrete choice questionnaires to participating patients at the end of 6 months of service provision. A latent class (LC) model was used to investigate each patient’s strength of preference and preference heterogeneity for several key attributes related to asthma service provision: frequency of visits, access to pharmacist, interaction with pharmacy staff, availability of a private area for consultation, provision of lung function testing, type and depth of advice provision, number of days with asthma symptoms and cost of service.
Results: Eighty useable questionnaires (of 170 questionnaires sent out) were received (response rate 47.1%). The study identified various key elements of asthma services important to patients. Further, the LC analysis revealed three classes with differing patient preferences for levels of asthma service provision. Patients in the Minimalistic Model class valued provision of lung function testing and preferred more frequent service visits. Cost of service had a negative effect on service preference for patients in this class. Patients in the Partial Model class mainly derived utility from the provision of lung function testing and comprehensive advice at the pharmacy and also wanted more frequent service visits. The Holistic Model class patients considered all attributes of the service to be important when making a choice. While the majority of the service attributes had a positive effect on preference for patients in this class, cost of service and days with symptoms of asthma had a negative effect on service preference. These patients also preferred fewer service visits.
Conclusion: The study identified various key attributes that are important to patients with respect to community pharmacy-based asthma services. The results also demonstrate the existence of preference heterogeneity in the population. Asthma service providers need to take these findings into consideration in the design and development of future service models so as to increase their uptake and ensure their long-term sustainability.
Asthma Asthma Patient Latent Class Analysis Discrete Choice Experiment Lung Function Testing
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The authors would like to thank the patients for their participation in the study as well as the pharmacists for their help in recruiting the patients. The authors would also like to thank two anonymous reviewers for their valuable comments and suggestions. They would like to acknowledge the Faculty of Pharmacy, University of Sydney (Sydney, NSW, Australia) for their postgraduate scholarship to one of the authors (Pradnya Naik-Panvelkar). The specialized Pharmacy Asthma Management Service (PAMS) was funded by the Australian Government Department of Health and Ageing as part of the Fourth Community Pharmacy Agreement; the PAMS funding did not extend to the discrete choice experiments reported in this manuscript in any way. The authors report no conflicts of interest and are alone responsible for the content and writing of the paper.
Pradnya Naik-Panvelkar conducted the DCE study, performed the analysis and wrote the manuscript. Dr Bandana Saini and Professor Carol Armour were members of the PAMS team and assisted in conducting the DCE study and critically revised the manuscript. Professor John Rose provided guidance on DCE instrument design, statistical analysis and critically revised the manuscript. Pradnya Naik-Panvelkar acts as a guarantor for the overall content.
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