Kleij Kim-Sarah, Tangermann Ulla, Amelung Volker E, Krauth Christian
Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
BMC Health Serv Res. 2017 Jul 11;17(1):476. doi: 10.1186/s12913-017-2433-7.
Primary care is a key element of health care systems and addresses the main health problems of the population. Due to the demographic change, primary care even gains in importance. The knowledge of the patients' preferences can help policy makers as well as physicians to set priorities in their effort to make health care delivery more responsive to patients' needs. Our objective was to describe which aspects of primary care were included in preference studies and which of them were the most preferred aspects.
In order to elicit the preferences for primary care, a systematic literature search was conducted. Two researchers searched three electronic databases (PubMed, Scopus, and PsycINFO) and conducted a narrative synthesis. Inclusion criteria were: focus on primary health care delivery, discrete choice experiment as elicitation method, and studies published between 2006 and 2015 in English language.
We identified 18 studies that elicited either the patients' or the population's preferences for primary care based on a discrete choice experiment. Altogether the studies used 16 structure attributes, ten process attributes and four outcome attributes. The most commonly applied structure attribute was "Waiting time till appointment", the most frequently used process attribute was "Shared decision making / professional's attention paid to your views". "Receiving the 'best' treatment" was the most commonly applied outcome attribute. Process attributes were most often the ones of highest importance for patients or the population. The attributes and attribute levels used in the discrete choice experiments were identified by literature research, qualitative research, expert interviews, or the analysis of policy documents.
The results of the DCE studies show different preferences for primary health care. The diversity of the results may have several reasons, such as the method of analysis, the selection procedure of the attributes and their levels or the specific research question of the study. As the results of discrete choice experiments depend on many different factors, it is important for a better comprehensibility of the studies to transparently report the steps undertaken in a study as well as the interim results regarding the identification of attributes and levels.
初级保健是卫生保健系统的关键要素，可解决人群的主要健康问题。由于人口结构变化，初级保健的重要性日益凸显。了解患者偏好有助于政策制定者和医生在努力使医疗服务更符合患者需求时确定优先事项。我们的目标是描述初级保健的哪些方面被纳入偏好研究，以及其中哪些是最受青睐的方面。
为了引出对初级保健的偏好，我们进行了系统的文献检索。两名研究人员搜索了三个电子数据库（PubMed、Scopus和PsycINFO）并进行了叙述性综合分析。纳入标准为：关注初级卫生保健服务、采用离散选择实验作为引出方法、2006年至2015年间以英文发表的研究。
我们确定了18项基于离散选择实验引出患者或人群对初级保健偏好的研究。这些研究总共使用了16个结构属性、10个过程属性和4个结果属性。最常应用的结构属性是“预约等待时间”，最常用的过程属性是“共同决策/专业人员对您观点的关注”。“接受‘最佳’治疗”是最常应用的结果属性。过程属性通常是对患者或人群最重要的属性。离散选择实验中使用的属性和属性水平是通过文献研究、定性研究、专家访谈或政策文件分析确定的。
DCE研究结果显示对初级卫生保健存在不同偏好。结果的多样性可能有多种原因，如分析方法、属性及其水平的选择程序或研究的具体研究问题。由于离散选择实验的结果取决于许多不同因素，为了更好地理解这些研究，透明地报告研究中采取的步骤以及关于属性和水平识别的中期结果非常重要。
