Determining patient preferences in a glaucoma service: A discrete choice experiment.

IMPORTANCE

Patient perspectives are crucial in informing design of acceptable services.

BACKGROUND

This study determined patient preferences in glaucoma care.

DESIGN

A discrete choice experiment was used to evaluate the relative importance of out-of-pocket costs, waiting time, continuity of care, service location and expertise.

PARTICIPANTS

Ninety-eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney.

METHODS

Twelve choice-tasks were presented in random order and forced-choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0).

MAIN OUTCOME MEASURES

The relative importance and the likelihood of choosing services with each attribute were determined. Willingness-to-pay and willingness-to-wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features.

RESULTS

Choice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out-of-pocket costs and shorter wait times (all P < .05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188-389) to see a senior eye doctor, and $87 (95% CI 60-116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients.

CONCLUSIONS AND RELEVANCE

Expertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out-of-pocket and concede longer waiting times to secure these preferences.