Preferences for GP versus pharmacist consultations for minor ailments

1
Preferences for GP versus pharmacist
consultations for minor ailments
Background Research shows that community
pharmacists (CP) can successfully deal with minor
ailments. Yet many users continue to consult GPs
about minor ailments and we do not understand why
many people make this choice. This study uses a
technique called Discrete Choice Experiment to
identify the factors important to people in
deciding whether to visit the CP or the GP when
seeking health advice on minor ailments. The
specific objective of this pilot study was to
ascertain the feasibility of performing a DCE to
elicit users preferences on the management of
minor ailments.
Method Discrete Choice Experiment
(DCE) Underpinning theory DCE is based on two
fundamental concepts of economic theory 1.
Consumers gain utility (satisfaction) from the
attributes of a good rather than from the good
itself (for instance a car gives utility to the
owner from its colour, reliability, etc) 2. If
we present a user with a series of product
options, we assume that the one chosen will be
that which gives the most utility (if a red
convertible is chosen, we assume red convertibles
are preferred to blue convertibles) Method There
are five stages in the conduct of a DCE (1)
identifying the attributes of interest (2)
assigning levels to each attribute (3) selecting
scenarios to present to respondents to choose
between (4) eliciting preferences and (5)
estimating the weights of each attribute. Respond
ents are asked to choose between a set of
alternative options. In health it could be
different visit types pairwise choices. Each
pairwise choice differs by including different
combinations and levels of the relevant
attributes identified as important. . Example You
have sore throat and you want to see an health
professional what would you do?
The magnitude of the beta coefficients indicates
the change in utility (satisfaction) associated
with change in level of the attribute. For
instance if when seen moves from not immediately
to immediately there is the largest change in
utility. The sign is also important because it
indicates an increase () as opposed to a
decrease (-) in satisfaction. In our model all
the attributes show the right sign (which means
that more is preferred seen immediately is
preferred to not being seen immediately, less
travel time is preferred to more travel time,
etc) The sign on location of consultation is
negative, indicating that everything being equal,
the chemist is less preferred to the GP, which is
also as expected. Interactions (location by
length and location by expenses) The one with
zero is the reference category (the one that
according to our coding represents the a less
preferred scenario). Coefficients in the other
cells represent moves from there. If the
location remains the GP, a move from a 5 to 10
minute consultation generates a large increase in
utility. On the other hand, a move in location
alongside a move in length, if definitely less
preferred to a five minutes consultation with the
CP. Which seems to suggest that if users go to
see the CP they prefer a quick consultation.
If the location remains the GP, a move from 5 to
10 minutes consultation generate a large increase
in utility. On the other hand, a move in location
alongside a move in length, is less preferred to
a five minute consultation with the CP which
suggests that if users go to the CP they prefer
a quick consultation (Table above). Being able
to save 2 and going to the GP gives the largest
increase of utility. Incurring 4 expenses and
seeing the CP gives a decrease in utility. If
there was some cost saving by going to the CP
(4?2) this gives an increase of utility. Which
seems to suggest that if users save by going to
the CP, then this becomes a satisfactory option
(Table below). This is very interesting in the
light of the abolition of prescription charges
undergoing in Wales

• Visit A
• See the GP
• Not immediately

• Visit B
• See the Chemist
• Immediately

Prefer A
Prefer B
Results A combination of literature review, focus
groups and piloting work led to the
identification of the following attributes and
levels for the study
Location of consultation Doctors
surgery Chemists shop Travel time 15
minutes 30 minutes When seen Immediately Not
immediately Length of consultation 5
minutes 10 minutes Expenses 2 4

• Discussion
• Respondents took an average of 14 minutes to fill
  the questionnaire and
• over 70 found it easy or very easy to complete
  (the cohort included
• a larger proportion of older people).
• Albeit only a pilot, the study shows some clear
  trend in users preferences
• Users want to be seen quickly with little travel
  time
• The abolition of prescription charges in Wales
  might lead to less
• substitution between GP and chemist.
• A national survey will investigate this further
  and assess the
• relationship between respondents socio-economic
  and demographic
• characteristics and choice made.

A two-level logistic regression was performed to
analyse the data. The analysis is based on the
answer from 109 respondents.
Acknowledgements This study was funded by the
Royal Pharmaceutical Society of Great Britain