Peng Yingying, Jiang Mingzhu, Shen Xiao, Li Xianglin, Jia Erping, Xiong Juyang
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, People's Republic of China.
Patient Prefer Adherence. 2020 Sep 17;14:1625-1637. doi: 10.2147/PPA.S265093. eCollection 2020.
The aim of this study was to quantify the relative importance of the preference heterogeneity of Chinese older adults with chronic disease for primary healthcare service (PHCS) in the hypothetical minor chronic disease scenario.
A discrete choice experiment (DCE) was administered to the patients aged 60 and above with at least one chronic disease in China. Five DCE attributes were considered, including types of service, treatment options, out-of-pocket (OOP) cost per visit, distance to practice, and the seniority of medical practitioners. DCE data were analysed taking into account of potential preference heterogeneity using both a mixed logit model (MLM) and a latent class logit model (LCLM).
A total of 432 respondents consented to complete the questionnaires and 372 valid respondents were included in analysis. All attributes were significantly influencing respondents' PHCS choice except for the types of service. Significant preference heterogeneity was observed among respondents. Based on the preferred LCLM estimates, four latent classes were identified. The first class (28.8%) valued modern medicine service the most, the second class (17.8%) was dominated by distance to practice, the third class (29%) preferred all the attributes except the types of services and valued TCM service most, the fourth class (24.4%) paid more attention to the types of service. Education, gender, age, income, regions of residence, and status of the chronic condition were found to be associated with latent class memberships.
A better understanding of the relative importance of PHCS characteristics is a crucial step for the future policy implementations. The significant preference heterogeneity identified in this study highlights that effective policy interventions should be tailored to different patients' characteristics.
本研究旨在量化在假设的轻度慢性病情景下，中国患有慢性病的老年人对基层医疗服务（PHCS）偏好异质性的相对重要性。
对中国60岁及以上患有至少一种慢性病的患者进行了离散选择实验（DCE）。考虑了五个DCE属性，包括服务类型、治疗选择、每次就诊的自付费用、到医疗机构的距离以及医生的资历。使用混合逻辑模型（MLM）和潜在类别逻辑模型（LCLM）对DCE数据进行分析，同时考虑潜在的偏好异质性。
共有432名受访者同意完成问卷，372名有效受访者纳入分析。除服务类型外，所有属性均对受访者的基层医疗服务选择有显著影响。受访者之间存在显著的偏好异质性。根据首选的LCLM估计，识别出四个潜在类别。第一类（28.8%）最看重现代医学服务，第二类（17.8%）主要受距离医疗机构远近影响，第三类（29%）除服务类型外偏好所有属性且最看重中医服务，第四类（24.4%）更关注服务类型。发现教育程度、性别、年龄、收入、居住地区和慢性病状况与潜在类别成员身份有关。
更好地理解基层医疗服务特征的相对重要性是未来政策实施的关键一步。本研究中发现的显著偏好异质性突出表明，有效的政策干预应根据不同患者的特征进行调整。
