Clinical Research Physiotherapist, Therapies Department, Royal National Orthopaedic Hospital, UK and PhD Student, School of Health Sciences, 7423University of Southampton, UK.
Associate Professor in Economics, Economics Department, Faculty of Economic, Social and Political Sciences, University of Southampton, UK.
J Health Serv Res Policy. 2022 Jan;27(1):62-73. doi: 10.1177/13558196211035427. Epub 2021 Aug 1.
Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting.
Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models.
Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks' time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients' access to resources, context for the consultation and the requirements of the consultation.
This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.
虚拟咨询可能会减少面对面门诊预约的需求，从而可能降低医疗保健的成本和时间。本研究报告了一项离散选择实验（DCE），该实验确定了影响患者在骨科康复环境中对虚拟咨询偏好的因素。
先前来自 CONNECT（骨科治疗、治疗负担和沟通技术的效果）项目和最佳实践指南的研究为我们的 DCE 的开发提供了信息。创建了一个具有 16 个选择场景的高效分数阶因子设计，该设计确定了所有主要效应和部分双向交互作用。该设计分为两个 8 个场景的块，以减少认知疲劳的影响。数据分析使用二项逻辑回归模型进行。
可用于分析的 61 对响应集（122 名受试者）。DCE 因素（治疗师是否为患者所熟知、预约持续时间、一天中的时间）和人口统计学因素（患者资格、是否有设备访问权限、日常活动的困难程度、有多个健康问题、旅行费用）是偏好的重要预测因素。我们估计，如果患者具有学位、无法访问进行虚拟咨询的设备和软件、没有日常活动困难、正在接受一个问题区域的康复治疗、旅行费用低于 5 英镑、正在与不认识的治疗师进行咨询、预约时间为 1 周、预约时间为 60 分钟、预约时间为下午 2 点，那么患者选择虚拟咨询的可能性低于 1%。我们已经开发了一个简单的概念模型来解释这些因素如何相互作用以告知偏好，包括患者对资源的访问、咨询的背景以及咨询的要求。
该概念模型为关注可能影响患者对虚拟咨询偏好的因素提供了框架。我们的模型可以为未来技术、试验和定性工作提供信息，以进一步探索影响偏好的机制。
