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Background Responding to the preferences of patients is a key focus of current health policy and is especially important in primary care. Responding effectively to patient preferences requires a clear understanding of the way in which patients assess primary care services.
Objective This study was designed to provide a ‘map’ of the content and structure of the key attributes of patient preferences concerning primary care.
Design The development of the ‘map’ used secondary research methods. Electronic databases were searched for published conceptual reviews of patient preferences, which were used to develop a basic ‘map’ through content analysis. A search for recently published primary empirical studies of patient preferences was conducted to extend and develop the ‘map’. The ‘map’ was tested by taking a random sample of patient assessment instruments and categorizing the item content.
Results Seven major categories and multiple subcategories were described. The major categories were access, technical care, interpersonal care, patient-centredness, continuity, outcomes, and hotel aspects of care. The coverage of these attributes in a selection of patient assessment instruments varied widely, and the coding of a proportion of items in the patient assessment instruments according to the ‘map’ was problematic.
Conclusions The conceptual ‘map’ can be used to plan comprehensive assessment of patient preferences in primary care. It also raises many theoretical issues concerning the nature of attributes and their interrelationships. The implications for the measurement of patient preferences are discussed.
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Responding to the preferences of patients concerning, the delivery of health care is an important aspect of current health policy worldwide.1 This is especially relevant to primary care, which has traditionally been viewed as health care, which is oriented to the needs of patients rather than focussed on technology.2,3
Generally, preferences are viewed as ideas about what should happen, which can be distinguished from patient satisfaction, which is the assessment of care that has been provided.4 It has been hypothesized that preferences will drive assessments of satisfaction, because meeting the needs of patients will generally lead to higher levels of satisfaction.5
Preferences for and satisfaction with non-health commodities (e.g. cars) will relate to many key attributes (e.g. comfort, speed and price). Although the exact process of decision-making in health care may be different, likely patient preferences for primary care will also involve many key attributes. Previous reviews have described several attributes, including availability and accessibility, practice organization, and communication, information and support.6 However, previous reviews may not exhaust all attributes of relevance, especially in the developing field of health care and health policy. For example, current government policy in the UK has highlighted the issue of ‘patient choice’ in health care.1
Understanding the key attributes underlying patient preferences concerning primary care is important. Technologies for the assessment of preferences and satisfaction (such as patient assessment questionnaires) are increasingly being linked with mechanisms of change (such as financial incentives). Therefore, the particular attributes included in those assessments may drive change, and if important attributes are omitted, there is a danger that change will prioritize certain attributes at the expense of others.7 In addition, within the context of the limited resources available to the National Health Service (NHS), patient preferences for certain attributes may be in conflict,8 which raises issues of priority.
Therefore, it is important to develop a clear understanding of the nature of patient preferences. Such an understanding requires both knowledge about the content of patient preferences (i.e. the different attributes of relevance) and the structure of those preferences (i.e. the way in which different attributes interrelate). Such an understanding can be likened to a conventional ‘map’, which illustrates both the content of an area (e.g. the key towns, rivers and elevation) and the relationships between them (e.g. distance and bearing).
Developing such a conceptual ‘map’ of the key attributes of primary care can involve many different methods. Qualitative work with patients is one obvious approach, but the resource intensive nature of such methods means that only a limited sample of views can be gathered, and the results may be very specific to the particular context of the data collection. In the present study, secondary research methods were used. The aims of the study were:
To develop a ‘map’ of the key attributes of primary care of importance to patients, indicating (a) the content of those attributes, (b) the relationship between different attributes.
To test the ‘map’ by examining the relationship between the attributes included in the ‘map’, and the attributes included in current patient assessment questionnaires used in the primary care setting.