Preferences for Enhanced Primary Care Services Among Older Individuals and Primary Care Physicians.
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2023-05
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Abstract
Objective
We aimed to identify the factors that are most important for community-dwelling older individuals (i.e., users) and primary care (PC) providers to enhance PC services.Methods
Discrete choice experiment surveys were administered to 747 individuals aged ≥ 60 years and 242 PC physicians in Singapore between December 2020 and August 2021. Participants were asked to choose between two hypothetical PC clinics and their current clinic. Latent class models were used to estimate the relative attribute importance (RAI) and to calculate the predicted uptake for enhanced PC services.Results
Based on the attributes and levels used in this study, the out-of-pocket cost (RAI: 47%) and types of services offered (RAI: 25%) were the most important attributes for users while working hours (RAI: 28%) and patient load (RAI: 25%) were the most important for providers. For out-of-pocket visit costs ranging from Singapore dollars (S)$100 to S$5, users' predicted uptake for enhanced PC services ranged from 46 to 84%. For daily patient loads ranging from 60 to 20 patients, providers' predicted uptake ranged from 64 to 91%, assuming their income remains unchanged.Conclusions
Our study provides timely insights for the development of strategies to support the government's new health care initiative (HealthierSG), which places PC at the center of Singapore's healthcare system. The ability to choose their preferred clinic, low out-of-pocket costs and types of services offered (for users), and reasonable working conditions (for providers) were the key factors for users and providers to participate in enhanced PC services.Type
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Ozdemir, Semra, John Ansah and David Matchar (2023). Preferences for Enhanced Primary Care Services Among Older Individuals and Primary Care Physicians. Applied health economics and health policy. pp. 1–13. 10.1007/s40258-023-00809-5 Retrieved from https://hdl.handle.net/10161/27531.
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Scholars@Duke
Semra Ozdemir
Dr. Ozdemir is an Associate Professor in the Department of Population Health Sciences at Duke University and is affiliated with Duke Clinical Research Institute. She also holds a joint appointment at the Signature Programme in Health Services and Systems Research at Duke-NUS Medical School in Singapore. Dr. Ozdemir’s research focuses on three areas of medical decision making: 1) assessing individuals’ preferences and values for healthcare services and products, 2) understanding the medical decision-making process among patients, their family caregivers, and clinicians, and 3) developing decision aids or tools to help individuals make better-informed medical decisions. She uses survey methods, cohort studies, and implementation science principles to conduct research in these areas.
Dr. Ozdemir is an expert in stated-preference methods and shared decision-making tools. Dr. Ozdemir led a large team of health communication and decision science experts and clinicians in the development of an educational and preference-based decision aid for older patients with end-stage kidney disease who are considering dialysis or kidney supportive care. She is an Associate Editor for Value in Health and has served on the editorial boards for Medical Decision Making and Applied Health Economics and Health Policy. She is also the co-chair of the Shared Decision Making Special Interest Group for the Society for Medical Decision Making.
Dr. Ozdemir loves running, paddling, traveling, and cheering for her sons in their soccer games and bike races.
Areas of expertise: Medical decision making, shared decision making, health preference assessment, stated-preference methods, decision aid research.
David Bruce Matchar
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
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