Wang Haode, Sun Hui, Jin Chunlin, Wang Meifeng, Luo Yashuang, Song Wenqian, Wang Haiyin
Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People's Republic of China.
Key Laboratory of Health Technology Assessment, National Health Commission; School of Public Health, Fudan University, Shanghai, People's Republic of China.
Patient Prefer Adherence. 2022 Aug 13;16:2103-2114. doi: 10.2147/PPA.S371188. eCollection 2022.
Shanghai is one of the pioneers proposing family doctor contract service (FDCS). However, there is no quantitative research focusing on the Shanghai experience from a demand-side perspective. This study investigated Shanghai chronic patients' relative preferences for FDCS using a discrete choice experiment method.
A face-to-face discrete choice experiment (DCE) was performed to elicit the preference with 300 samples. Attributes and levels were extracted from the literature review and focus group consultation with patients. Seven attributes, follow-up frequency, medicine accessibility, family doctor competency, health management, referral convenience, appointment flexibility, and shared decision-making, were decided. Three levels were attached to each attribute. A mixed logit model was used to evaluate the multiple-choice data.
A total of 248 patients completed the survey. Patient valued FDCS medicine accessibility (β=0.57, P < 0.05), and high family doctor competency (β= 0.43, P < 0.05), regular health management activities (β=0.36, P < 0.05), high follow-up frequency (β=0.31, P < 0.05) the most. The good doctor-patient shared decision-making atmosphere (β=0.12, P < 0.05), high referral convenience (β=0.06, P < 0.05) and high appointment flexibility (β=0.04, P < 0.05) are valued as less important. No significant preference heterogeneity was identified for patients with different sociodemographic characteristics. Respondents reported other FDCS needs, including online health consultation, specialist services in local institutes, higher reimbursement rates, free rehabilitation guidance for the disabled and personal health management.
This research is the first discrete choice experiment FDCS preference research targeting on Chinese urban population. The results suggested that to increase the quality of FDCS, policy-makers should prioritize follow-up frequency, medicine accessibility, family doctor competency and health management. The service package should consider a higher reimbursement rate and rehabilitation guidance for the disabled if extra health-care resources available. Future FDCS policy should consider stated societal preference and be congruent with it.
上海是提出家庭医生签约服务（FDCS）的先驱之一。然而，从需求方角度对上海经验进行定量研究的却很少。本研究采用离散选择实验方法调查了上海慢性病患者对家庭医生签约服务的相对偏好。
进行了一项面对面的离散选择实验（DCE），以获取300个样本的偏好。通过文献综述和与患者的焦点小组咨询提取了属性和水平。确定了七个属性，即随访频率、药品可及性、家庭医生能力、健康管理、转诊便利性、预约灵活性和共同决策。每个属性都有三个水平。使用混合logit模型评估多项选择数据。
共有248名患者完成了调查。患者最看重家庭医生签约服务的药品可及性（β=0.57，P<0.05）、家庭医生的高能力（β=0.43，P<0.05）、定期的健康管理活动（β=0.36，P<0.05）以及高随访频率（β=0.31，P<0.05）。良好的医患共同决策氛围（β=0.12，P<0.05）、高转诊便利性（β=0.06，P<0.05）和高预约灵活性（β=0.04，P<0.05）被认为不太重要。不同社会人口学特征的患者未发现显著的偏好异质性。受访者还报告了其他家庭医生签约服务需求，包括在线健康咨询、当地机构的专科服务、更高的报销率、为残疾人提供免费康复指导以及个人健康管理。
本研究是首个针对中国城市人口的家庭医生签约服务偏好的离散选择实验研究。结果表明，为提高家庭医生签约服务质量，政策制定者应优先考虑随访频率、药品可及性、家庭医生能力和健康管理。如果有额外的医疗资源，服务包应考虑提高报销率和为残疾人提供康复指导。未来的家庭医生签约服务政策应考虑既定的社会偏好并与之保持一致。
