Hagemi Anke, Plumpton Catrin, Hughes Dyfrig A
Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Bangor, Wales, UK.
Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, Wales, LL57 2PZ, UK.
BMC Nephrol. 2017 Oct 2;18(1):305. doi: 10.1186/s12882-017-0720-5.
Prescribing policy recommendations aimed at moving immunosuppressant prescribing for renal transplant patients from primary to secondary care may result in benefits of increased safety and reduced cost. However, there is little evidence of patients' preferences for receiving their immunosuppressant therapy from hospitals compared to community dispensing. The aim of this study was to elicit patient preferences for different service configurations focusing in particular on home delivery versus collection of medication from hospital.
A discrete choice experiment was administered to 265 renal transplant patients in North Wales. Respondents were presented 18 pairwise choices, labelled as either home delivery or hospital collection, and described by the attributes: frequency of supply, waiting time (for delivery or collection) and method of ordering (provider contact, patient contact via phone, patient contact electronically). Data were analysed using a random-effects logit model and marginal rates of substitution calculated based on the waiting time attribute.
A response rate of 63% was achieved, with 5332 usable observations from 150 respondents. Method of delivery (β coefficient 1.21; 95% confidence interval 1.05 to 1.38), frequency of supply (0.05; 0.03 to 0.08) waiting time (-0.00, -0.00 to -0.00), provider contact (desirable) (0.20; 0.12 to 0.27), patient contact by telephone (desirable) (0.09; 0.01 to 0.17) and patient contact electronically (undesirable) (-0.292; -0.37 to -0.21) were statistically significant (p < 0.05). Results indicate that patients are willing to increase waiting time by nearly 10 h to have a home delivery service.
Patients indicate a clear preference for a home delivery service. They prefer providers to make contact when new immunosuppressant supplies are required and show preference against ordering medication electronically. A policy for secondary care prescribing and hospital collection of medicines does not align with this preference.
旨在将肾移植患者免疫抑制剂处方从初级医疗转移至二级医疗的处方政策建议可能会带来安全性提高和成本降低的益处。然而，与社区配药相比，几乎没有证据表明患者更倾向于在医院接受免疫抑制治疗。本研究的目的是了解患者对不同服务配置的偏好，尤其关注药品的家庭配送与医院取药。
对北威尔士的265名肾移植患者进行了一项离散选择实验。向受访者呈现18对选择，标记为家庭配送或医院取药，并由供应频率、等待时间（配送或取药）和订购方式（供应商联系、患者电话联系、患者电子联系）等属性进行描述。使用随机效应逻辑模型分析数据，并根据等待时间属性计算边际替代率。
回复率为63%，150名受访者有5332条可用观察结果。配送方式（β系数1.21；95%置信区间1.05至1.38）、供应频率（0.05；0.03至0.08）、等待时间（-0.00，-0.00至-0.00）、供应商联系（可取）（0.20；0.12至0.27）、患者电话联系（可取）（0.09；0.01至0.17）和患者电子联系（不可取）（-0.292；-0.37至-0.21）具有统计学意义（p<0.05）。结果表明，患者愿意增加近10小时的等待时间以获得家庭配送服务。
患者明确表示更喜欢家庭配送服务。他们希望在需要新的免疫抑制剂供应时由供应商联系，并且不倾向于电子订购药品。二级医疗处方和医院取药政策与这种偏好不一致。
