Patientenpräferenzen und Wartebereitschaft für eine medizinisch-beruflich orientierte orthopädische Rehabilitation: ein Discrete Choice Experiment

Abstract

Implementing a stronger patient orientation needs a secured knowledge about wants, preferences and quality standards of the persons concerned. In international health services research discrete choice experiments (DCE) have been used to analyse such complex preferences for some years. The method uses comparisons of two or more services that vary in several attributes to achieve attribute-related decisions to one of the services. From these decisions the relative importance of the attributes considered can be estimated. A DCE was conducted to explore the preferences of rehabilitants concerning the design of orthopaedic rehabilitation. Additionally, the study should enable analyses concerning the theoretical validity of the approach. Data collection was realised within a cluster randomised trial examining the efficacy of a work-related orthopaedic rehabilitation. The DCE considered four attributes (offer of a social counselling service, offer of a work-related stress coping training, intensity of therapy, waiting time). For the questionnaire nine choice sets were generated from the potential programmes. The analyses considered data of 223 patients finishing 1796 choice sets. Respondents preferred the offer of a social counselling service (beta=0.20; 95% CI: 0.10 to 0.30), the offer of a work-related stress coping training (beta=0.70; 95% CI: 0.60 to 0.80), rising the intensity from 3 to 5 hours (beta=0.36; 95% CI: 0.21 to 0.50) and reduced waiting time (beta=-0.07; 95% CI: -0.10 to -0.03). Relative importance (RI) was highest for the offer of a stress coping training (RI=45.7%). For such an offer the respondents were willing to wait 10 additional weeks. A model segmented for persons with convenient and less convenient stress coping strategies confirmed higher benefit gains for persons with a lower ability to disassociate oneself from work-related strains (chi(2)=13.27; p<0.001). High benefit expectations of employed persons concerning a work-related stress coping training within an orthopaedic rehabilitation support that a sufficient acceptance and compliance is expectable when implementing an appropriate intervention. As the realisation of a stronger patient orientation needs knowledge about patient preferences, development of German health services could benefit from conducting DCE.