Healthcare professionals’ preferences for the specialist pharmacy service medicines advice clinical enquiry service: a discrete choice experiment

Abstract

Abstract Introduction The Specialist Pharmacy Service Medicines Advice (SPS-MA) service answers enquiries from primary care professionals in England. The preferences of service users for the way this service is provided (e.g. opening hours, speed and route of reply, amount of detail in answer etc.) are unknown. Such information would be useful to ensure the service meets the needs of users as well as possible within the constraints of available resources. Aim To determine healthcare professionals’ preferences for the Specialist Pharmacy Service Medicines Advice clinical enquiry service using a discrete choice experiment (DCE). Methods International Society for Pharmacoeconomics and Outcomes Research good research practices were used to conduct a DCE1. Previous literature2, documentary analysis of SPS-MA policies, and interviews with four SPS-MA enquirers and three SPS-MA service providers/managers identified seven key attributes of the clinical enquiry service. Each attribute could be defined using one of 2-3 descriptions (‘levels’). A D-efficient experimental design generated 20 pairs of potential clinical enquiry service variants, each described by one level linked to each of the seven attributes. These 20 pairs were blocked into two online surveys (10 pairs per survey), which asked participants to choose which service from each pair they would prefer to contact. The 1669 SPS-MA clinical enquiry contacts with a recorded email in the year to November 2023 were randomised to receive an email invitation to complete one of the survey variants. Preferences for each attribute level were estimated using conditional logit regression. Using the HRA decision tool, this project was not considered research by the NHS. It was given a favourable opinion by the University of Bath ethics review process on 27th November 2023 (reference 1153-2222). Results 236 participants completed a survey (52% GP pharmacists, 26% other pharmacists, 22% other professional; median 15 years’ experience). Weekend opening and opening hours did not significantly affect preferences (p≥0.226). All other attributes did significantly affect preferences (p≤0.015). An answer within one hour or two days was most valued (preference weightings (95%CI) relative to five days: 0.89 (0.76-1.03) and 0.58 (0.45-0.72), respectively). Communication by email was highly valued (preference weighting: 0.62 (0.47-0.77) relative to telephone only). The availability of a website of frequently asked questions was also valued (preference weighting: 0.48 (0.31-0.64) relative to no website). Answering the telephone within 20 seconds and a detailed response were valued, but to a lesser degree. Sub-group analysis found that participants qualified for <15 years valued email communication and detailed responses more strongly than other participants (p≤0.035). Discussion / Conclusion Where clinically appropriate, the SPS-MA clinical enquiry service should prioritise speed of reply, communication by email and a website of frequently asked questions. Longer opening hours are not required. This is the first study to use of a DCE to investigate professional enquirers’ preferences for a medicines information/advice service. This allowed analysis of the strength of preferences and how they were traded off. Due to the small number of non-pharmacist enquirers to the SPS-MA service, it was not possible to investigate how professional background influences preferences.