Li Xiaona, Ma Dongping, Feng Zhiqiang, Gao Min, Dong Ping, Shi Yongli, Li Ziyuan, Li Runmin, Yin Wenqiang, Chen Zhongming
School of Management, Shandong Second Medical University, Weifang, China.
China National Health Development Research Center, Beijing, China.
Front Med (Lausanne). 2024 Oct 9;11:1439136. doi: 10.3389/fmed.2024.1439136. eCollection 2024.
Multiple Chronic Diseases (MCD) are the co-occurrence of two or more chronic conditions within an individual. Compared to patients with a single chronic disease, those with MCD face challenges related to polypharmacy, which increases the risk of adverse drug events, side effects, and drug-drug interactions. Understanding the specific medication preferences of patients with MCD is crucial to optimize treatment plans and enhance treatment safety.
This study aims to evaluate the medication preferences among patients with multiple chronic diseases in rural areas of an eastern province of China.
A discrete choice experiment (DCE) was used to measure patients' medication preferences. According to literature research, expert panel discussions, and in-depth patient interviews, we identified six attributes: monthly out-of-pocket cost, onset speed of action, adverse effects, whether it is covered by health insurance, origin of medications, and types of medications. The conditional logit models (CLM) and mixed logit models (MIXL) were used to evaluate the choice data. Willingness to pay (WTP) was used to reflect the monetary value that patients were willing to pay or receive reimbursement after changes in different attribute levels.
A total of 956 respondents were included in the analysis. Of which, 68.62% were female, with an average age of 68 years, and 65.89% had a Body Mass Index (BMI) greater than or equal to 24. Statistical significance was observed for all attributes ( < 0.001). The preferred medication for patients encompassed low monthly out-of-pocket costs, rapid onset of action, rare adverse effects, and a preference for Western medicine, health insurance-covered medication and domestic medication. The onset speed of action was a primary consideration for patients, who demonstrated a willingness to pay an additional CNY151.37 per month for a medication with a rapid onset of action.
Rural patients with multiple chronic diseases preferred medications with rapid onset, rare adverse, Western medications, domestic medication, and health insurance-covered medication. Medical staff can effectively combine the Health Belief Model (HBM) to help patients with multiple chronic diseases improve their confidence and understanding of medication selection, to improve their health management.
多种慢性病（MCD）是指个体同时患有两种或更多种慢性疾病。与患有单一慢性疾病的患者相比，患有多种慢性病的患者面临与多重用药相关的挑战，这增加了药物不良事件、副作用和药物相互作用的风险。了解患有多种慢性病的患者的具体用药偏好对于优化治疗方案和提高治疗安全性至关重要。
本研究旨在评估中国东部某省农村地区患有多种慢性病的患者的用药偏好。
采用离散选择实验（DCE）来衡量患者的用药偏好。根据文献研究、专家小组讨论和深入的患者访谈，我们确定了六个属性：每月自付费用、起效速度、不良反应、是否有医疗保险覆盖、药物产地和药物类型。使用条件logit模型（CLM）和混合logit模型（MIXL）来评估选择数据。支付意愿（WTP）用于反映患者在不同属性水平变化后愿意支付或接受报销的货币价值。
共有956名受访者纳入分析。其中，68.62%为女性，平均年龄68岁，65.89%的体重指数（BMI）大于或等于24。所有属性均具有统计学意义（<0.001）。患者偏好的药物包括每月自付费用低、起效快、不良反应少，并且偏好西药、有医疗保险覆盖的药物和国产药物。起效速度是患者的首要考虑因素，患者愿意为起效快的药物每月额外支付151.37元。
农村多种慢性病患者更喜欢起效快、不良反应少的西药、国产药物以及有医疗保险覆盖的药物。医务人员可以有效地结合健康信念模型（HBM），帮助患有多种慢性病的患者提高对药物选择的信心和理解，以改善他们的健康管理。
