Taylor Susan, Hourihan Fleur, Krass Ines, Armour Carol
Faculty of Pharmacy, The University of Sydney, NSW ( Australia ).
Centre for Rural and Remote Mental Health, Orange NSW ( Australia ).
Pharm Pract (Granada). 2009 Oct;7(4):195-204. doi: 10.4321/s1886-36552009000400002. Epub 2009 Mar 15.
Evaluation of a community pharmacy disease management program for type 2 diabetes, 'SugarCare', was conducted. Compared with the standard care offered by pharmacists, this enhanced program offered patients closer monitoring of blood glucose levels, counselling about lifestyle, etc. The SugarCare study was funded by a grant but if the care is to continue some other method of financing must be found.
This study aimed to measure consumer preference for one of the two types of care offered in the SugarCare study, the control/standard and the intervention/enhanced service; the strength of that preference; and participants' willingness to pay (WTP) for their preferred care.
SugarCare was a parallel groups, control versus intervention, repeated measures design conducted in three areas of NSW, Australia. Patients in the Intervention group (enhanced care) had one initial visit to the pharmacy with six follow up visits over approximately 9 months. At these visits blood glucose was downloaded and patient care issues addressed. At the end of the service, a survey instrument was mailed to the intervention and control participants who were asked to read it and then expect a telephone call within 2 weeks of receipt. Responses were requested over the phone and the survey instrument completed by the researcher. WTP data were collected using a modified payment card method.
Overall, 44/75 (59%; 47%-70% 95%CI) respondents expressed a preference for Scenario B (the enhanced care) while 31/75 (41%; 31%-52% 95%CI) preferred Scenario A (standard care) however, the difference was not statistically significant. The median maximum WTP was AUD10 for the enhanced care and AUD3.50 for the standard care (p<0.03).
While the WTP values expressed were significantly higher for the enhanced care they did not match with the cost providing that diabetes care. Discrete choice analysis has the potential to overcome some of the difficulties encountered with the contingent valuation technique used here. Further research is required before WTP values such as these could be used with confidence to determine funding policy.
对一项针对2型糖尿病的社区药房疾病管理项目“SugarCare”进行了评估。与药剂师提供的标准护理相比，这个强化项目为患者提供了更密切的血糖水平监测、生活方式咨询等。SugarCare研究由一笔赠款资助，但如果要继续提供这种护理，必须找到其他融资方式。
本研究旨在衡量消费者对SugarCare研究中提供的两种护理类型之一的偏好，即对照/标准护理和干预/强化服务；这种偏好的强度；以及参与者为其偏好的护理支付的意愿（WTP）。
SugarCare是一项平行组、对照与干预、重复测量设计，在澳大利亚新南威尔士州的三个地区进行。干预组（强化护理）的患者最初到药房就诊一次，在大约9个月内进行6次随访。在这些就诊时，下载血糖数据并解决患者护理问题。在服务结束时，向干预组和对照组参与者邮寄一份调查问卷，要求他们阅读并预计在收到后的2周内会接到电话。通过电话获取回复，由研究人员完成调查问卷。使用改良的支付卡方法收集WTP数据。
总体而言，44/75（59%；47%-70% 95%CI）的受访者表示偏好方案B（强化护理），而31/75（41%；31%-52% 95%CI）的受访者更喜欢方案A（标准护理），然而，差异无统计学意义。强化护理的最大WTP中位数为10澳元，标准护理为3.50澳元（p<0.03）。
虽然强化护理的WTP值明显更高，但与提供糖尿病护理的成本不匹配。离散选择分析有可能克服此处使用的条件估值技术所遇到的一些困难。在能够自信地使用此类WTP值来确定资助政策之前，还需要进一步研究。
