探索慢性阻塞性肺病患者的偏好,为资源分配提供依据:离散选择实验研究。

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM BMJ Open Respiratory Research Pub Date : 2024-10-09 DOI:10.1136/bmjresp-2023-001914
Jack Ettinger, Anita Patel, Julius Ohrnberger, Chris Moore, Manjula Bhudiya, Wayne Smith
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引用次数: 0

摘要

导言:慢性阻塞性肺病(COPD)的治疗方法有很多,但坚持治疗仍是一项关键挑战。我们进行了一项离散选择实验(DCE),以了解患者在获得慢性阻塞性肺病治疗护理方面的偏好。这项研究旨在了解患者对慢性阻塞性肺病治疗护理方式的偏好。这项工作随后被用于为英格兰五个综合医疗系统(ICS)的资源分配决策提供依据:方法:2022 年 8 月至 9 月,我们邀请五个综合医疗系统中确诊患有慢性阻塞性肺病的患者完成一项在线调查。根据最小重叠、水平平衡和正交原则进行实验设计,创建了 20 组共 11 种情景供参与者评估。参与者会看到三个假设选项,并被要求选择他们最喜欢的选项或表示没有最喜欢的选项。数据采用分层贝叶斯算法进行分析:在研究地区的 82 639 名慢性阻塞性肺病患者中,有 520 人完成了调查。使用 EuroQol 5-Dimensions 5-Level 得出的健康相关生活质量平均得分为 0.57 (0.29)。最重要的属性是治疗效果、治疗方法和提供治疗的工作人员类型。症状稍有缓解(22.75 (SD 78.80))或有所缓解(20.67 (46.77))的效用水平平均值大大高于症状完全缓解(-43.42 (83.03))的效用水平平均值。在各种治疗方案中,患者更倾向于亲自预约治疗(平均效用得分 48.34 (SD 48.14)),并认为由医护人员提供护理非常重要 (77.50 (64.39)):DCE方法可以帮助患者做出资源分配决策,表明患者最重视的属性以及他们愿意在获得和提供治疗方面做出的权衡。
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Exploration of preferences among people with COPD to inform resource allocation: a discrete choice experiment study.

Introduction: Treatment options for chronic obstructive pulmonary disease (COPD) are numerous but adherence remains a key challenge. We performed a discrete choice experiment (DCE) of patients' preferences in accessing care for the management of COPD. The aim of this study was to understand patients' preferences for modes of accessing care for the management of COPD. This piece of work was then used to inform resource allocation decisions in five integrated care systems (ICSs) in England.

Methods: People with diagnosed COPD in five ICSs were invited to complete an online survey from August to September 2022. An experimental design built on the principles of minimal overlap, level balance and orthogonality was used to create 20 sets of 11 scenarios for participants to assess. Participants were presented with three hypothetical options and asked to select their most preferred or state that none was preferred. Data were analysed using a hierarchal Bayes algorithm.

Results: Of 82 639 patients with COPD in the study area, 520 completed the survey. The mean health-related quality of life score derived using EuroQol 5-Dimensions 5-Level was 0.57 (0.29). The attributes assigned greatest importance were treatment outcomes, treatment delivery and the type of staff who deliver treatment. Mean utility level scores were substantially higher for little relief (22.75 (SD 78.80)) or some relief from symptoms (20.67 (46.77)) than for complete relief (‒43.42 (83.03)). Of the treatment delivery options, in-person individual appointments were preferred (mean utility score 48.34 (SD 48.14)), and care being provided by healthcare professionals was viewed as very important (77.50 (64.39)).

Conclusions: The DCE approach can help resource allocation decisions by indicating attributes most important to patients and trade-offs they are willing to make in treatment access and delivery.

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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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