School of Health and Related Research (ScHARR), University of Sheffield, UK.
School of Health and Related Research (ScHARR), University of Sheffield, UK.
Soc Sci Med. 2022 May;301:114885. doi: 10.1016/j.socscimed.2022.114885. Epub 2022 Mar 11.
High and sustained healthcare quality is important worldwide, though health policy may prioritise the achievement of certain aspects of quality over others. This study determines the relative importance of different aspects of mental healthcare quality to different stakeholders by eliciting preferences in a UK sample using a discrete choice experiment (DCE). DCE attributes were generated using triangulation between policy documents and mental healthcare service user and mental healthcare professional views, whilst ensuring attributes were measurable using available data. Ten attributes were selected: waiting times; ease of access; person-centred care; co-ordinated approach; continuity; communication, capacity and resources; treated with dignity and respect; recovery focus; inappropriate discharge; quality of life (QoL). The DCE was conducted online (December 2018 to February 2019) with mental healthcare service users (n = 331), mental healthcare professionals (n = 510), and members of the general population (n = 1018). Respondents' choices were analysed using conditional logistic regression. Relative preferences for each attribute were generated using the marginal rate of substitution (MRS) with QoL as numeraire. Across all stakeholders, being treated with dignity and respect was of high importance. A coordinated approach was important across all stakeholders, whereas communication had higher relative importance for healthcare professionals and service users and ease of access had higher relative importance for the general population. This implies that policy could be affected by the choice of whose preferences (service users, healthcare professionals or general population) to use, since this impacts on the relative value and implied ranking of different aspects of mental healthcare quality.
高质量且持续的医疗保健在全球范围内都很重要，尽管卫生政策可能会优先考虑实现某些方面的质量，而不是其他方面。本研究通过在英国样本中使用离散选择实验（DCE）来确定不同利益相关者对精神卫生保健质量不同方面的相对重要性。DCE 属性是通过政策文件与精神卫生保健服务使用者和精神卫生保健专业人员的观点之间的三角关系产生的，同时确保使用现有数据可以衡量属性。选择了十个属性：等待时间；易于获取；以患者为中心的护理；协调方法；连续性；沟通、能力和资源；得到尊严和尊重的待遇；康复重点；不当出院；生活质量（QoL）。DCE 于 2018 年 12 月至 2019 年 2 月在网上进行，对象包括精神卫生保健服务使用者（n=331）、精神卫生保健专业人员（n=510）和一般人群（n=1018）。使用条件逻辑回归分析受访者的选择。使用边际替代率（MRS）并以 QoL 为基准数生成每个属性的相对偏好。在所有利益相关者中，得到尊严和尊重的待遇非常重要。协调方法对所有利益相关者都很重要，而沟通对医疗保健专业人员和服务使用者的相对重要性更高，而对一般人群来说，易于获取的相对重要性更高。这意味着政策可能会受到选择使用谁的偏好（服务使用者、医疗保健专业人员或一般人群）的影响，因为这会影响精神卫生保健质量不同方面的相对价值和隐含排名。
