Kaambwa Billingsley, Lancsar Emily, McCaffrey Nicola, Chen Gang, Gill Liz, Cameron Ian D, Crotty Maria, Ratcliffe Julie
Flinders Health Economics Group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA 5041, Adelaide, Australia.
Centre for Health Economics, Faculty of Business and Economics, Level 2, Building 75 Monash University, Clayton, Victoria 3800, Australia.
Soc Sci Med. 2015 Sep;140:81-94. doi: 10.1016/j.socscimed.2015.06.034. Epub 2015 Jun 30.
Consumer directed care (CDC) is currently being embraced internationally as a means to promote autonomy and choice for consumers (people aged 65 and over) receiving community aged care services (CACSs). CDC involves giving CACS clients (consumers and informal carers of consumers) control over how CACSs are administered. However, CDC models have largely developed in the absence of evidence on clients' views and preferences. We explored CACS clients' preferences for a variety of CDC attributes and identified factors that may influence these preferences and potentially inform improved design of future CDC models. Study participants were clients of CACSs delivered by five Australian providers. Using a discrete choice experiment (DCE) approach undertaken in a group setting between June and December 2013, we investigated the relative importance to CACS consumers and informal (family) carers of gradations relating to six salient features of CDC (choice of service provider(s), budget management, saving unused/unspent funds, choice of support/care worker(s), support-worker flexibility and level of contact with service coordinator). The DCE data were analysed using conditional, mixed and generalised logit regression models, accounting for preference and scale heterogeneity. Mean ages for 117 study participants were 80 years (87 consumers) and 74 years (30 informal carers). All participants preferred a CDC approach that allowed them to: save unused funds from a CACS package for future use; have support workers that were flexible in terms of changing activities within their CACS care plan and; choose the support workers that provide their day-to-day CACSs. The CDC attributes found to be important to both consumers and informal carers receiving CACSs will inform the design of future CDC models of service delivery. The DCE approach used in this study has the potential for wide applicability and facilitates the assessment of preferences for elements of potential future aged care service delivery not yet available in policy.
消费者导向型照护（CDC）目前在国际上受到广泛采用，作为一种手段，旨在为接受社区老年照护服务（CACSs）的消费者（65岁及以上人群）促进自主性和选择权。CDC涉及给予CACS客户（消费者及其非正式照护者）对CACS管理方式的控制权。然而，CDC模式在很大程度上是在缺乏关于客户观点和偏好的证据的情况下发展起来的。我们探讨了CACS客户对各种CDC属性的偏好，并确定了可能影响这些偏好的因素，这些因素可能为未来CDC模式的改进设计提供参考。研究参与者是由五家澳大利亚服务提供商提供的CACS的客户。我们采用离散选择实验（DCE）方法，于2013年6月至12月期间在小组环境中进行，调查了CDC六个显著特征（服务提供商的选择、预算管理、节省未使用/未花费资金、支持/照护人员的选择、支持人员的灵活性以及与服务协调员的联系程度）的不同等级对CACS消费者和非正式（家庭）照护者的相对重要性。使用条件、混合和广义logit回归模型对DCE数据进行分析，同时考虑偏好和规模异质性。117名研究参与者的平均年龄分别为80岁（87名消费者）和74岁（30名非正式照护者）。所有参与者都倾向于一种CDC方式，这种方式允许他们：从CACS套餐中节省未使用的资金以备将来使用；拥有在CACS护理计划内灵活调整活动的支持人员；选择提供日常CACS服务的支持人员。对于接受CACS服务的消费者和非正式照护者而言，被发现重要的CDC属性将为未来CACS服务提供模式的设计提供参考。本研究中使用的DCE方法具有广泛适用性的潜力，并有助于评估对政策中尚未出现的潜在未来老年照护服务提供要素的偏好。
