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Burns JG, Glenk K, Eory V, Simm G, Wall E. Preferences of European dairy stakeholders in breeding for resilient and efficient cattle: A best-worst scaling approach. J Dairy Sci 2021; 105:1265-1280. [PMID: 34955264 DOI: 10.3168/jds.2021-20316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
Including resilience in the breeding objective of dairy cattle is gaining increasing attention, primarily as anticipated challenges to production systems, such as climate change, may make some perturbations more difficult to moderate at the farm level. Consequently, the underlying biological mechanisms by which resilience is achieved are likely to become an important part of the system itself, increasing value on the animal's ability to be unperturbed by variable production circumstances, or to quickly return to pre-perturbed levels of productivity and health. However, because the value of improving genetic traits to a system is usually based on known profit functions or bioeconomic models linked to current production conditions, it can be difficult to define longer-term value, especially under uncertain future production circumstances and where nonmonetary values may be progressively more important. We present the novel application of a discrete choice experiment, used to investigate potential antagonisms in the values of genetic improvements for 8 traits to dairy cattle system stakeholders in Europe when the production goal was either efficiency or resilience. A latent class model was used to identify heterogeneous preferences within each production goal, and postestimation was used to identify associations between these preferences and sociodemographic characteristics of respondents. Results suggested 3 distinct latent preference classes for each production goal. For the efficiency goal, yield and feed efficiency traits were generally highly valued, whereas for the resilience goal, health and robustness traits were generally highly valued. In both cases, these traits generally carried a low value in the other production scenario. Overall, in both scenarios, longevity was highly valued; however, the value of this trait in terms of resilience will depend on phenotyping across diverse environments to sufficiently capture performance under various anticipated system challenges. Additionally, results showed significant associations between membership of latent preference classes with education level and profession. In conclusion, as resilience becomes increasingly important, it is likely that a continued reliance on the short-term economic value of traits alone will lead decision makers to misrepresent the importance of some traits, including those with substantial contextual values in terms of resilience.
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Affiliation(s)
- J G Burns
- Global Academy of Agriculture and Food Security, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, United Kingdom; Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom.
| | - K Glenk
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom
| | - V Eory
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom
| | - G Simm
- Global Academy of Agriculture and Food Security, University of Edinburgh, Easter Bush Campus, Edinburgh, EH25 9RG, United Kingdom
| | - E Wall
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, Edinburgh, EH9 3JG, United Kingdom
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Xu RH, Zhou LM, Wong ELY, Wang D. Investigating Medical Student's Preferences for Internet-Based Healthcare Services: A Best-Worst Scaling Survey. Front Public Health 2021; 9:757310. [PMID: 34938703 PMCID: PMC8685198 DOI: 10.3389/fpubh.2021.757310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to investigate the importance of providing Internet-based healthcare services based on the preference of a sample of medical students in China. Methods: An online best-worst scaling (BWS) survey with Case 1 design was conducted. Balanced independent block design generated 12 choice task profiles for each participant to answer. Descriptive analysis was used to describe the respondents' characteristics; Multinomial and mixed logit regression methods were used to investigate the importance of Internet-based services based on respondents' preferences. Results: A total of 1,296 students completed the online survey and rated "Clinical Service," "Decision Aids," and "Public health" as the three most important services that should be provided through an Internet-based healthcare system. Providing "Medical Education" via the Internet was chosen as the least important service by the respondents. Subgroup analysis indicated that students studying clinical medicine and non-clinical medicine considered providing "Medical Education" and "Public Health," respectively, as more important services than others. Conclusions: This BWS study demonstrated that providing "Clinical Service," "Decision Aids," and "Public Health" through the Internet are the three most important services based on medical students' preferences in China. Further research is needed to investigate how to improve medical students' skills in using internet-based healthcare services in medical education programs.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- JC School of Public Health and Primary Care The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ling-ming Zhou
- School of Health Management Southern Medical University, Guangzhou, China
| | - Eliza Lai-yi Wong
- JC School of Public Health and Primary Care The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Dong Wang
- School of Health Management Southern Medical University, Guangzhou, China
- Institute of Health Management Southern Medical University, Guangzhou, China
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Wu A, Parris RS, Scarella TM, Tibbles CD, Torous J, Hill KP. What gets resident physicians stressed and how would they prefer to be supported? A best-worst scaling study. Postgrad Med J 2021; 98:930-935. [PMID: 34810273 DOI: 10.1136/postgradmedj-2021-140719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Physician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy. METHODS This cross-sectional study used best-worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020). RESULTS Top-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as 'would realistically consider intervention') and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options. CONCLUSION BWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.
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Affiliation(s)
- Andrew Wu
- Psychiatry, Harvard Medical School, Boston, Massachusetts, USA .,Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ritika S Parris
- Office of Graduate Medical Education, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy M Scarella
- Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Carrie D Tibbles
- Office of Graduate Medical Education, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - John Torous
- Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin P Hill
- Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Rheindorf J, Hagist C, Schlereth C. Call (and pay) the midwife: A discrete choice experiment on mothers' preferences and their willingness to pay for midwifery care. Int J Nurs Stud 2021; 124:104096. [PMID: 34695625 DOI: 10.1016/j.ijnurstu.2021.104096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mothers in Germany are entitled to midwifery care; however, they face a lack of skilled professionals. While the reliability of the access to midwifery is of great public interest, we know little about clients' preferences. OBJECTIVES We conduct a discrete choice experiment to study preferences and willingness to accept copayment for the entire scope of midwifery care (pregnancy, delivery, and postnatal). Thereby, we aim to provide policy recommendations for priority settings in times of scarcity. Furthermore, we evaluate to what extent midwives' education matters to parents and assess the degree of support for the latest Midwifery Reform Act that transfers education from vocational schools to universities. DESIGN Discrete choice experiment with separated adaptive dual response. SETTINGS Online Survey promoted through Facebook to parents in Germany. RESPONDENTS 2080 respondents completed the experiment. They all have or are expecting at least one natural child, mainly born between 2018 and 2020 (87%). The average respondent is female (99%), 33 years old, with a university degree (50%). METHODS We use a d-optimal fractional factorial design and obtain individual parameter estimates through a Multinomial Logit analysis with Hierarchical Bayes estimation techniques. We calculate willingness to pay and importance weights and simulate uptake probabilities for different packages of care. To avoid extreme choice behavior, we apply separated adaptive dual response. RESULTS Home visits during the postnatal phase are most important (importance weight 50%); online support is demanded when no personal support is available. We find that 1:1 care during delivery is highly preferred, but one midwife supporting two women intrapartum is still acceptable. The midwife´s education plays a minor role with an importance weight of 3%; however, we find a preference for midwives trained at vocational schools rather than at universities. CONCLUSIONS In times of scarcity, postnatal care in the form of home visits should be prioritized over pregnancy counseling, and online services should be promoted as an add-on but not as a substitute for personal support. There is a high level of willingness to accept co-financing to ensure the availability of services usually covered by health insurance.
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Affiliation(s)
- Jessica Rheindorf
- WHU - Otto Beisheim School of Management, Burgplatz 2, 56179 Vallendar, Germany.
| | - Christian Hagist
- WHU - Otto Beisheim School of Management, Burgplatz 2, 56179 Vallendar, Germany.
| | - Christian Schlereth
- WHU - Otto Beisheim School of Management, Burgplatz 2, 56179 Vallendar, Germany.
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Wu A, Radhakrishnan V, Targan E, Scarella TM, Torous J, Hill KP. Self-Reported Preferences for Help-Seeking and Barriers to Using Mental Health Supports Among Internal Medicine Residents: Exploratory Use of an Econometric Best-Worst Scaling Framework for Gathering Physician Wellness Preferences. JMIR MEDICAL EDUCATION 2021; 7:e28623. [PMID: 34612838 PMCID: PMC8529465 DOI: 10.2196/28623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/23/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Burnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions. OBJECTIVE This study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers. METHODS Internal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options. RESULTS Of the 163 invited residents, 77 (47.2% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71%; worst: 0.6%) and support from friends and family (best: 70%; worst: 1.6%). Top-ranking barriers to seeking counseling included time (best: 75%; worst: 5%) and money (best: 35%; worst: 21%). CONCLUSIONS Overall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework.
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Affiliation(s)
- Andrew Wu
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Varsha Radhakrishnan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Elizabeth Targan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timothy M Scarella
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kevin P Hill
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Guerrini CJ, Crossnohere NL, Rasmussen L, Bridges JFP. A best-worst scaling experiment to prioritize concern about ethical issues in citizen science reveals heterogeneity on people-level v. data-level issues. Sci Rep 2021; 11:19119. [PMID: 34580327 PMCID: PMC8476613 DOI: 10.1038/s41598-021-96743-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
"Citizen science" refers to the participation of lay individuals in scientific studies and other activities having scientific objectives. Citizen science gives rise to unique ethical issues that stem from the potentially multifaceted contributions of citizen scientists to the research process. We sought to explore the ethical issues that are most concerning to citizen scientist practitioners, participants, and scholars to support ethical practices in citizen science. We developed a best-worst scaling experiment using a balanced incomplete block design and fielded it with respondents recruited through the U.S.-based Citizen Science Association. Respondents were shown repeated subsets of 11 ethical issues and identified the most and least concerning issues in each subset. Latent class analysis revealed two respondent classes. The "Power to the People" class was most concerned about power imbalance between project leaders and participants, exploitation of participants, and lack of diverse participation. The "Show Me the Data" class was most concerned about the quality of data generated by citizen science projects and failure of projects to share data and other research outputs.
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Affiliation(s)
- Christi J Guerrini
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 220N Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Lisa Rasmussen
- Department of Philosophy, The University of North Carolina Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 220N Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
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57
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Geerinck A, Locquet M, Hiligsmann M, Reginster JY, Bruyère O, Beaudart C. Patients' preferences for quality-of-life aspects in sarcopenia: a best-worst scaling study. Eur Geriatr Med 2021; 13:483-491. [PMID: 34561818 DOI: 10.1007/s41999-021-00563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE As information on patients' preferences regarding quality-of-life aspects in sarcopenia is lacking, this study aims to assess the relative importance of the 14 items of a QoL questionnaire designed for sarcopenia (the SF-SarQoL) using a best-worst scaling (BWS) survey. METHODS Participants, aged 65 years or older and community dwelling, who previously participated in the SarcoPhAge study, received a BWS survey via the mail. An object case BWS was selected in which participants completed 12 choice tasks, picking the most and least important aspect from 4 out of 14 SF-SarQoL items for each task. Relative importance scores (RIS) were estimated using Hierarchical Bayes modelling. A cluster analysis was also conducted to investigate whether several profiles with regards to QoL preferences were present. RESULTS A total of 163 participants were included, aged 75 (IQR: 73-81) years old, and mostly women (n = 107; 65.6%). Two items were found to be significantly more important than others: "feeling a reduction of physical capacity" (RIS = 11.26), and "having balance problems" (RIS = 11.09). The least important items were "experiencing difficulty carrying heavy objects" (RIS = 2.89), and "feeling a reduction in muscle mass" (RIS = 3.82). We found relatively weak evidence for the presence of two clusters. One cluster prioritized items related to falls where the second prioritized items related to feeling physically capable. CONCLUSION Not all QoL aspects were equally important. The relative weight of each QoL aspect may be used to interpret QoL results obtained with the SF-SarQoL or to inform target outcomes in interventional studies.
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Affiliation(s)
- Anton Geerinck
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium.
| | - Médéa Locquet
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Evangelidis N, Sautenet B, Madero M, Tong A, Ashuntantang G, Sanabria LC, de Boer IH, Fung S, Gallego D, Levey AS, Levin A, Lorca E, Okpechi IG, Rossignol P, Sola L, Usherwood T, Wheeler DC, Cho Y, Howell M, Guha C, Scholes-Robertson N, Widders K, Gonzalez AM, Teixeira-Pinto A, Viecelli AK, Bernier-Jean A, Anumudu S, Dunn L, Wilkie M, Craig JC. Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD): a protocol for establishing a core outcome set for adults with chronic kidney disease who do not require kidney replacement therapy. Trials 2021; 22:612. [PMID: 34503563 PMCID: PMC8427149 DOI: 10.1186/s13063-021-05574-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Globally, over 1.2 million people die from chronic kidney disease (CKD) every year. Patients with CKD are up to 10 times more likely to die prematurely than progress to kidney failure requiring kidney replacement therapy. The burden of symptoms and impaired quality of life in CKD may be compounded by comorbidities and treatment side effects. However, patient-important outcomes remain inconsistently and infrequently reported in trials in patients with CKD, which can limit evidence-informed decision-making. The Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD) aims to establish a consensus-based core outcome set for trials in patients with CKD not yet requiring kidney replacement therapy to ensure outcomes of relevance to patients, caregivers and health professionals are consistently reported in trials. METHODS SONG-CKD involves four phases: a systematic review to identify outcomes (domains and measures) that have been reported in randomised controlled trials involving adults with CKD who do not require kidney replacement therapy; stakeholder key informant interviews with health professionals involved in the care of adults with CKD to ascertain their views on establishing core outcomes in CKD; an international two-round online Delphi survey with patients, caregivers, clinicians, researchers, policy makers and industry representatives to obtain consensus on critically important outcome domains; and stakeholder consensus workshops to review and finalise the set of core outcome domains for trials in CKD. DISCUSSION Establishing a core outcome set to be reported in trials in patients with CKD will enhance the relevance, transparency and impact of research to improve the lives of people with CKD. TRIAL REGISTRATION Not applicable. This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database: http://www.comet-initiative.org/Studies/Details/1653 .
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Affiliation(s)
- Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia.
| | - Benedicte Sautenet
- Department of Nephrology, CHU Tours, INSERM SPHERE U1246, University of Tours, University of Nantes, Tours, France
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Gloria Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Laura Cortes Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Ian H de Boer
- Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Samuel Fung
- Division of Nephrology, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Daniel Gallego
- Federacion Nacional ALCER (Spanish Kidney Patient's Federation), Madrid, Spain
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Eduardo Lorca
- Department of Nephrology, Hospital Salvador, Santiago, Chile
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Clinique 1433 and Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT, Nancy, France
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Tim Usherwood
- The University of Sydney, Westmead Clinical School, Westmead, NSW, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Katherine Widders
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Amelie Bernier-Jean
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Samaya Anumudu
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Patient preferences in the treatment of hemophilia A: A latent class analysis. PLoS One 2021; 16:e0256521. [PMID: 34424920 PMCID: PMC8382185 DOI: 10.1371/journal.pone.0256521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine subgroup-specific treatment preferences and characteristics of patients with hemophilia A. METHODS Best-Worst Scaling (BWS) Case 3 (four attributes: application type; bleeding frequencies/year; inhibitor development risk; thromboembolic events of hemophilia A treatment risk) conducted via online survey. Respondents chose the best and the worst option of three treatment alternatives. Data were analyzed via latent class model (LCM), allowing capture of heterogeneity in the sample. Respondents were grouped into a predefined number of classes with distinct preferences. RESULTS The final dataset contained 57 respondents. LCM analysis segmented the sample into two classes with heterogeneous preferences. Preferences within each were homogeneous. For class 1, the most decisive factor was bleeding frequency/year. Respondents seemed to focus mainly on this in their choice decisions. With some distance, inhibitor development was the second most important. The remaining attributes were of far less importance for respondents in this class. Respondents in class 2 based their choice decisions primarily on inhibitor development, also followed, by some distance, the second most important attribute bleeding frequency/year. There was statistical significance (P < 0.05) between the number of annual bleedings and the probability of class membership. CONCLUSIONS The LCM analysis addresses heterogeneity in respondents' choice decisions, which helps to tailor treatment alternatives to individual needs. Study results support clinical and allocative decision-making and improve the quality of interpretation of clinical data.
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Parent clinical trial priorities for fragile X syndrome: a best-worst scaling. Eur J Hum Genet 2021; 29:1245-1251. [PMID: 34163011 PMCID: PMC8385075 DOI: 10.1038/s41431-021-00922-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/19/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023] Open
Abstract
An expansion in the availability of clinical drug trials for genetic neurodevelopmental conditions is underway. Delineating patient priorities is key to the success of drug development and clinical trial design. There is a lack of evidence about parent decision-making in the context of clinical drug trials for genetic neurodevelopmental conditions. We assessed parents' priorities when making a decision whether to enroll their child with fragile X syndrome (FXS) in a clinical drug trial. An online survey included a best-worst scaling method for parents to prioritize motivating and discouraging factors for child enrollment. Parents were recruited through the National Fragile X Foundation and FRAXA. Sequential best-worst with conditional logit analysis was used to determine how parents prioritize motivating and discouraging factors about trial enrollment decisions. Respondents (N = 354) were largely biological mothers (83%) of an individual with FXS who ranged in age from under 5 to over 21 years. The highest motivating factor was a trial to test a drug targeting the underlying FXS mechanism (coeff = 3.28, p < 0.001), followed by the potential of the drug to help many people (coeff = 3.03, p < 0.001). Respondents rated requirement of blood draws (coeff = -3.09, p < 0.001), loss of access to the drug post trial (coeff = -3.01, p < 0.001), and drug side effects (coeff = -2.96, p < 0.001) as most discouraging. The priorities defined by parents can be incorporated into evidence-based trial design and execution to enhance the enrollment process.
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Improving Severity Scoring of Food-Induced Allergic Reactions: A Global "Best-Worst Scaling" Exercise. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4075-4086.e5. [PMID: 34293502 PMCID: PMC8592392 DOI: 10.1016/j.jaip.2021.06.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/29/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is no current consensus on assigning severity to food-induced allergic reactions, for example, to assess the efficacy of allergen immunotherapy. Existing severity scores lack the capability to discriminate between non-anaphylaxis reactions of different severities. Attempts are ongoing to develop a more discriminatory score, which should ideally be data-driven and validated in multiple cohorts. OBJECTIVE To undertake an exercise using best-worst scaling (BWS) to define a potential gold standard against which severity scoring of food-induced allergic reactions can be refined. METHODS We undertook a global survey to better understand how health care professionals rate the severity of food-induced allergic reactions, using BWS methodology. Respondents were given a number of patient case vignettes describing real-world allergic reactions and asked to select the pair that, in their opinion, reflected the maximum difference in severity. Responses were then modeled and a preference score (representing severity) determined for each scenario. Scenarios were also scored using existing published scoring systems and the scores compared with the BWS score using Spearman r correlation and Cohen kappa. Given the differences in definitions of anaphylaxis globally, we also evaluated differences in BWS ranking depending on the geographical location of respondents. RESULTS We received 334 complete responses, 183 (55%) from Europe and 65 (20%) from North America. Perception of severity of some reactions appeared to be affected by geographical location. The comparison of BWS ranking with current grading systems identified significant issues that varied from one grading system to another, such as prominence to some symptoms (eg, vomiting) that skew grading when using scoring systems not designed for food allergy. In general, current scoring systems poorly discriminate against more mild symptoms and often overestimate their severity. CONCLUSIONS These data provide a methodology free of user scale bias to help define a potential, consensus-driven gold standard that can be used to guide and validate the development of improved grading systems to score food-induced allergic symptoms and highlight areas for education where there is the potential to miscategorize severity.
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Osman AMY, Wu J, He X, Chen G. Eliciting SF-6Dv2 health state utilities using an anchored best-worst scaling technique. Soc Sci Med 2021; 279:114018. [PMID: 33993008 DOI: 10.1016/j.socscimed.2021.114018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
There is an increasing interest in using ordinal data collection methods, such as the best-worst scaling (BWS), to develop preference-based tariffs (value sets) for health-related quality of life instruments, yet the evidence on their performance is limited. This paper proposed to use an anchored BWS technique (in which the state of "death" served as an anchoring state) to directly develop a utility weight that lies on a scale anchored at 0 = death and 1 = full health for the Simplified Chinese version of the Short Form 6 Dimension version 2 (SF-6Dv2). An online panel from the general population of Mainland China completed an online survey between 20th July and 19th August, 2019 and 463 respondents were included in the main analysis. The Conditional Logit (CL) model, which assumes a homogeneous preference, as well as a Hierarchical Bayes (HB) model, which accounts for preference heterogeneity, were used to analyze the BWS data. The model performances were evaluated based on monotonicity and model-fit statistics. The majority of respondents indicated that the BWS questions were easy to understand and complete. Initial analyses suggested that the best and worst choices should not be pooled together. Based on model fit statistics of separated estimations and previous literature on health state valuation studies using BWS, the best choices were used for developing the final algorithm. The HB estimates were found to have better model performance than the CL estimates. This study provides an essential insight into using an anchored BWS approach in health state valuation. Furthermore, it demonstrates the advantage of using HB compared to the traditional CL model in producing preference values.
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Affiliation(s)
- Ahmed M Y Osman
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, PR China; Center for Social Science Survey and Data, Tianjin University, Tianjin, PR China.
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, PR China; Center for Social Science Survey and Data, Tianjin University, Tianjin, PR China.
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, PR China; Center for Social Science Survey and Data, Tianjin University, Tianjin, PR China.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, Victoria, Australia.
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Most Important Factors for Deciding Rehabilitation Provision for Severe Stroke Survivors Post Hospital Discharge: A Study Protocol for a Best-Worst Scaling Experiment. Methods Protoc 2021; 4:mps4020027. [PMID: 34066439 PMCID: PMC8163167 DOI: 10.3390/mps4020027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Efficient decision-making is crucial to ensure adequate rehabilitation with optimal use of healthcare resources. Establishing the factors associated with making decisions concerning rehabilitation provision is important to guide clinical staff towards person-centred decisions for rehabilitation after severe stroke. In this study we conduct a best–worst scaling (BWS) experiment to identify the most important factors and their relative weight of importance for deciding the type of ongoing rehabilitation services a person with severe stroke might receive post hospital discharge. Fractional, efficient designs are applied regarding the survey design. Key multidisciplinary staff regularly involved in making decisions for rehabilitation in a stroke unit will be recruited to participate in an online BWS survey. Hierarchical Bayes estimation will be used as the main analysis method, with the best–worst count analysis as a secondary analysis. The survey is currently being piloted prior to commencing the process of data collection. Results are expected by the end of September 2021. The research will add to the current literature on clinical decision-making in stroke rehabilitation. Findings will quantify the preferences of factors among key multi-disciplinary clinicians working in stroke units in the UK, involved in decision-making concerning rehabilitation after stroke.
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Webb EJD, Meads D, Lynch Y, Judge S, Randall N, Goldbart J, Meredith S, Moulam L, Hess S, Murray J. Attribute Selection for a Discrete Choice Experiment Incorporating a Best-Worst Scaling Survey. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:575-584. [PMID: 33840436 DOI: 10.1016/j.jval.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/23/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Although literature exists on using qualitative methods to generate potential attributes for a discrete choice experiment (DCE), there is little on selecting which attributes to include. We present a case study in which a best-worst scaling case 1 (BWS-1) survey was used to guide attribute selection for a DCE. The case study's context was the decision making of professionals around the choice of augmentative and alternative communication (AAC) systems for children with limited natural speech. METHODS BWS-1 survey attributes were generated from literature reviews and focus groups. DCE attributes were selected from BWS-1 attributes. The selection criteria were: include mostly important attributes; create coherent descriptions of children and AAC systems; address the project's research aims; have an appropriate respondent burden. Attributes' importance was judged using BWS-1 relative importance scores. RESULTS The BWS-1 survey included 19 child and 18 AAC device/system attributes and was administered to N = 93 AAC professionals. Four child and five device/system attributes were selected for the DCE, administered to N = 155 AAC professionals. CONCLUSIONS In this case study BWS-1 results were useful in DCE attribute selection. Four recommendations are made for future studies: define selection criteria for DCE attributes a priori; consider the impact participant's perspective will have on BWS-1 and DCE results; clearly define key terminology at the start of the study and refine it as the study progresses to reflect interim findings; BWS will be useful when there is little existing stated preference work on a topic and/or qualitative work is difficult.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK; Choice Modelling Centre, University of Leeds, Leeds, England, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK; Choice Modelling Centre, University of Leeds, Leeds, England, UK
| | - Yvonne Lynch
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, England, UK
| | - Simon Judge
- Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, England, UK; Institute for Transport Studies, University of Leeds, Leeds, England, UK
| | - Nicola Randall
- Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, England, UK
| | - Juliet Goldbart
- Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, England, UK
| | - Stuart Meredith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Liz Moulam
- Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, England, UK
| | - Stephane Hess
- Choice Modelling Centre, University of Leeds, Leeds, England, UK
| | - Janice Murray
- Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, England, UK
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Clark VL, Gibson PG, McDonald VM. What matters to people with severe asthma? Exploring add-on asthma medication and outcomes of importance. ERJ Open Res 2021; 7:00497-2020. [PMID: 33816596 PMCID: PMC8005593 DOI: 10.1183/23120541.00497-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/08/2020] [Indexed: 12/19/2022] Open
Abstract
There is an increasing number of new therapies for severe asthma; however, what outcomes people with severe asthma would like improved and what aspects they prioritise in new medications remain unknown. This study aimed to understand what outcomes are important to patients when prescribed new treatments and to determine the characteristics of importance to patients in their choice of asthma treatments. Participants with severe asthma (n=50) completed a cross-sectional survey that ranked 17 potential hypothetical outcomes of treatment using a seven-point Likert scale, as well as selecting their top five overall outcomes. Participants also completed hypothetical scenarios trading off medication characteristics for four hypothetical add-on asthma treatments. Participants (58% male), had a mean±sd age of 62.2±13.5 years. Their top three prioritised outcomes were: to improve overall quality of life (selected by 83% of people), reduce number and severity of asthma attacks (72.3%), and being able to participate in physical activity (59.6%) When trading off medication characteristics, the majority of patients with severe asthma chose the hypothetical medication with the best treatment efficacy (68%). However, a subgroup of patients prioritised the medication's side-effect profile and mode of delivery to select their preferred medication. People with severe asthma value improved quality of life as an important outcome of treatment. Shared decision-making discussions between clinicians and patients that centre around medication efficacy and side-effect profile can incorporate patient preferences for add-on therapy in severe asthma. Improving quality of life is an important treatment outcome. Shared decision-making discussions between clinicians and patients that centre around efficacy and side-effect profile incorporate patient preferences for add-on therapy in severe asthma.https://bit.ly/2GY1Sc4
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Affiliation(s)
- Vanessa L Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, NSW, Australia.,School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, NSW, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, NSW, Australia.,School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Fischman V, Wittenberg E, Song SA, Huston MN, Franco RA, Song PC, Naunheim MR. How Patients Choose a Laryngologist: A Pilot Stated Preference Study. OTO Open 2021; 5:2473974X21999601. [PMID: 33796810 PMCID: PMC7968048 DOI: 10.1177/2473974x21999601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Patients consider many factors when deciding how to receive medical care. This study used best-worst scaling (BWS), a technique novel to otolaryngology, to quantitatively examine preferences among patients choosing a laryngologist. Our objective was to quantify in a pilot cohort the relative importance patients place on a variety of attributes when seeking a laryngologist. Study Design BWS survey. Setting Academic voice clinic. Methods New patients were recruited to take a computerized BWS survey developed using attributes derived from patient input, expert opinion, and literature review. Attributes were grouped into 4 categories: physician reputation, physician qualifications, hospital-related factors, and other nonclinical factors. Responses were analyzed using multinomial logit regression to determine importance scores and associations with other variables. Results Eighty-seven of 93 patients recruited participated (93.5% response rate). Physician qualifications were the most important attributes to patients, with specialty laryngology training receiving the highest importance score (20.8; 95% CI, 20.2 to 21.5; P < .0001). Recommendations from referring physicians (15.6; 95% CI, 14.3 to 16.9) and use of cutting-edge technology (11.9; 95% CI, 10.7 to 13.1) were the second and third most important, respectively. Least important were nonclinical factors, including wait time to get an appointment (4.3; 95% CI, 2.8 to 5.8) and convenience of office location (1.5; 95% CI, 0.9 to 2.1). Just over half of patients (51.2%) reported willingness to wait 4 weeks for an appointment with a laryngologist. Older patients were less concerned with convenience-related factors. Conclusion Nonclinical factors were less important to patients than clinical factors, and laryngology-specific training was paramount. Stated preference methodologies can elucidate underlying preferences and help providers make care more patient centered.
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Affiliation(s)
- Victoria Fischman
- Tufts University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Eve Wittenberg
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sungjin A Song
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri, USA
| | - Ramon A Franco
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip C Song
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Yang Y, Thapa R, Lewis FM. Using Best-Worst Scaling to Determine the Most Burdensome Menopausal Symptoms in Cambodian Women Living With HIV. J Assoc Nurses AIDS Care 2021; 32:174-187. [PMID: 33449581 DOI: 10.1097/jnc.0000000000000226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT As persons living with HIV live longer, it is important to understand the symptoms experienced by menopausal women living with HIV (WLWH). This study used best-worst scaling (BWS) to determine the menopausal symptoms that are most burdensome for Cambodian WLWH. Participants were asked to rate a list of menopausal symptoms in terms of the most and least burdensome in their lives via BWS. The final analysis included 183 participants, 67 of whom were premenopausal, 47 perimenopausal, and 69 postmenopausal women. Physical and mental exhaustion (mean best-worst score = 319) was rated as the most burdensome symptom, and hot flushes and sweating were the least burdensome (mean best-worst score = -181). The BWS provides information on priorities for the distribution of health care resources. Understanding how Cambodian WLWH prioritize burdensome menopausal symptoms is crucial for choosing the most contextually sensitive method to provide health care services and interventions.
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Affiliation(s)
- Youngran Yang
- Youngran Yang, PhD, MPH, RN, is an Associate Professor, School of Nursing, Research Institute of Nursing Science, Sustainable Development Center, Jeonbuk National University, Jeonju, Korea. Roshna Thapa, MSN, RN, is a Research Assistant, School of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea. Frances Marcus Lewis, PhD, RN, FAAN, is an Endowed Professor in Nursing, Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, Washington, USA
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Richardson DR, Oakes AH, Crossnohere NL, Rathsmill G, Reinhart C, O'Donoghue B, Bridges JFP. Prioritizing the worries of AML patients: Quantifying patient experience using best-worst scaling. Psychooncology 2021; 30:1104-1111. [PMID: 33544421 DOI: 10.1002/pon.5652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 01/06/2023]
Abstract
CONTEXT Although patients with acute myeloid leukemia (AML) experience significant toxicities and poor outcomes, few studies have quantified patients' experience. METHODS A community-centered approach was used to develop an AML-specific best-worst scaling (BWS) instrument involving 13 items in four domains (psychological, physical, decision-making, and treatment delivery) to quantify patient worry. A survey of patients and caregivers was conducted using the instrument. Data were analyzed using conditional logistic regression. RESULTS The survey was completed by 832 patients and 237 caregivers. Patients were predominantly white (88%), married/partnered (72%), and in remission (95%). The median age was 55 years (range: 19-87). Median time since diagnosis was 8 years (range: 1-40). Patients worried most about "the possibility of dying from AML" (BWS score = 15.5, confidence interval [CI] [14.2-16.7]) and "long-term side effects of treatments" (14.0, CI [12.9-15.2]). Patients found these items more than twice as worrisome as all items within the domains of care delivery and decision-making. Patients were least worried about "communicating openly with doctors" (2.50, CI [1.97-3.04]) and "having access to the best medical care" (3.90, CI [3.28-4.61]). Caregiver reports were highly correlated to patients' (Spearman's ρ = 0.89) though noted significantly more worry about the possibility of dying and spending time in the hospital. CONCLUSION This large convenience sample demonstrates that AML patients have two principal worries: dying from their disease and suffering long-term side effects from treatment. To better foster patient-centered care, therapeutic decision-making and drug development should reflect the importance of both potential outcomes. Further work should explore interventions to address these worries.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison H Oakes
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gary Rathsmill
- Leukemia & Lymphoma Society, White Plains, New York, USA
| | - Crystal Reinhart
- Center for Prevention Research and Development, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | | | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Trukeschitz B, Hajji A, Batchelder L, Saloniki E, Linnosmaa I, Malley J. What's important when caring for a loved one? Population-based preference weights for the Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) for Austria. Qual Life Res 2021; 30:1975-1984. [PMID: 33598854 PMCID: PMC8233248 DOI: 10.1007/s11136-021-02775-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/05/2022]
Abstract
Purpose The Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) can be used to assess long-term care-related quality of life (LTC-QoL) of adult informal carers of persons using LTC services. The ASCOT-Carer instrument has been translated into several languages, but preference weights reflecting the relative importance of different outcome states are only available for England so far. In this paper, we estimated preference weights for the German version of the ASCOT-Carer for Austria and investigated the value people place on different QoL-outcome states. Methods We used data from a best–worst scaling (BWS) experiment and estimated a scale-adjusted multinomial logit (S-MNL) model to elicit preference weights for the ASCOT-Carer domain-levels. Data were collected using an online survey of the Austrian general population (n = 1001). Results Top levels in the domains of ‘Space and time to be yourself’, ‘Occupation’ and ‘Control over daily life’ were perceived as providing the highest utility, and states with high needs in the same domains seen as particularly undesirable. ‘Personal safety’ was the only domain where levels were roughly equidistant. In all other domains, the difference between the top two levels (‘ideal state’ and ‘no needs’) was very small. Conclusion The paper provides preference weights for the German version of ASCOT-Carer to be used in Austrian populations. Furthermore, the results give insight into which LTC-QoL-outcomes are seen as particularly (un)desirable, and may therefore help to better tailor services directed at informal carers and the persons they care for.
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Affiliation(s)
- Birgit Trukeschitz
- Research Institute for Economics of Aging, WU Vienna University of Economics and Business, Welthandelsplatz 1, D5, 1020, Vienna, Austria.
| | - Assma Hajji
- Research Institute for Economics of Aging, WU Vienna University of Economics and Business, Welthandelsplatz 1, D5, 1020, Vienna, Austria
| | - Laurie Batchelder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Eirini Saloniki
- Personal Social Services Research Unit, University of Kent, Canterbury, UK.,Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Ismo Linnosmaa
- Centre for Health and Social Economics, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Juliette Malley
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
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Williams NJ, Candon M, Stewart RE, Byeon YV, Bewtra M, Buttenheim AM, Zentgraf K, Comeau C, Shoyinka S, Beidas RS. Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment. BMC Psychiatry 2021; 21:74. [PMID: 33541301 PMCID: PMC7863375 DOI: 10.1186/s12888-021-03072-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders' values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders' preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling. METHODS A total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. RESULTS On average, stakeholders preferred two strategies significantly more than all others-compensation for use of EBP per session and compensation for preparation time to use the EBP (P < .05); two strategies were preferred significantly less than all others-performance feedback via email and performance feedback via leaderboard (P < .05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n = 80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n = 90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics. CONCLUSIONS The presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders' implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.
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Affiliation(s)
| | - Molly Candon
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Vivian Byeon
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meenakshi Bewtra
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Zentgraf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carrie Comeau
- Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), Philadelphia, PA, USA
| | - Sonsunmolu Shoyinka
- Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.
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Voshaar MJH, Vriezekolk JE, van Dulmen AM, van den Bemt BJF, van de Laar MAFJ. Ranking facilitators and barriers of medication adherence by patients with inflammatory arthritis: a maximum difference scaling exercise. BMC Musculoskelet Disord 2021; 22:21. [PMID: 33407344 PMCID: PMC7786955 DOI: 10.1186/s12891-020-03874-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Facilitators and barriers of adherence to disease-modifying anti-rheumatic drugs (DMARDs) have been identified by patients with inflammatory arthritis earlier. However, the relative importance from the patients’ perspective of these factors is unknown. Knowledge on this ranking might guide the development of interventions and may facilitate targeted communication on adherence. This study aims to examine 1) the relative importance patients attach to facilitators and barriers for DMARDs adherence, and 2) the relationship between patient characteristics and ranking of these factors. Methods One hundred twenty-eight outpatients with inflammatory arthritis; (60% female, mean age 62 years (SD = 12), median disease duration 15 years, IQR (7, 23) participated in a Maximum Difference scaling exercise and ranked 35 items based upon previously identified facilitators and barriers to medication adherence. Hierarchical Bayes estimation was used to compute mean Rescaled Probability Scores (RPS; 0–100) (i.e. relative importance score). Kendall’s coefficient of concordance was used to examine a possible association between patients’ characteristics (i.e. age, sex and educational level) and ranking of the items. Results The three most important items ranked by patients were: Reduction of symptoms formulated as “Arthritis medications help to reduce my symptoms” (RPS = 7.30, CI 7.17–7.44), maintaining independence formulated as “I can maintain my independence as much as possible” (RPS = 6.76, CI 6.54–6.97) and Shared decision making formulated as “I can decide –together with my physician- about my arthritis medications” (RPS = 6.48, CI 6.24–6.72). No associations between patient characteristics and ranking of factors were found. Conclusions Reducing symptoms, maintaining independency and shared decision making are patients’ most important factors for DMARDs adherence. This knowledge might guide the development of interventions and may facilitate communication between health professionals and their patients on medication adherence.
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Affiliation(s)
- M J H Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - J E Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A M van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South- Eastern Norway, Drammen, Norway
| | - B J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, RadboudUMC, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M A F J van de Laar
- Arthritis Centre Twente, Medisch Spectrum Twente & University of Twente, P.O box 50,000, 7500, KA, Enschede, The Netherlands
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72
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Wranik WD, Székely RR, Mayer S, Hiligsmann M, Cheung KL. The most important facilitators and barriers to the use of Health Technology Assessment in Canada: a best-worst scaling approach. J Med Econ 2021; 24:846-856. [PMID: 34162282 DOI: 10.1080/13696998.2021.1946326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Health Technology Assessment (HTA), which can support public drug reimbursement decisions will play a core function in the planned national Pharmacare program in Canada. To address existing barriers to the use of HTA, these must be ranked in order of priority. The goal of this study was to access the relative importance of known facilitators and barriers to the use of HTA in the context of the Canadian health care system, with attention to differences between regions and stakeholder groups. METHODS We used the best-worst scaling object case approach to elicit a quantitative ranking of a list of 20 facilitators and 22 barriers. A sample of 68 Canadian HTA stakeholders, including members of expert committees, decision/policymakers, researchers/academics, and others participated in the study. Their task was to identify the most important and the least important item in 12 sub-sets of five facilitators and 14 sub-sets of five barriers. FINDINGS Relative Importance Scores derived via hierarchical Bayes analysis revealed relations, engagement, and contact between stakeholders as most important on both the barrier and facilitator sides. Other top-ranked facilitators included the availably of credible and relevant research. Other top-ranked barriers included inconsistencies in the evidence and limited generalizability. The availability of HTA guidelines did not rank highly on either side. The main limitation of the study was the challenge with reaching the relevant respondents; this was mitigated by involving the national HTA agency in the research. CONCLUSION Canadian stakeholders consider the relationships within the HTA network among the most important. Policies should focus on strengthening these relationships. Future research should focus on the connectivity and distribution of knowledge and power within the HTA network.
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Affiliation(s)
- Wiesława Dominika Wranik
- Faculty of Management, School of Public Administration, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
- Jean Monnet European Union Centre of Excellence, Dalhousie University, Halifax, Canada
| | - Ronaldo-Raul Székely
- Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Mickaël Hiligsmann
- Faculty of Health Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health and Life Sciences, Brunel University London, London, UK
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73
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Al-Omari B, McMeekin P, Bate A. Systematic Review of Studies Using Conjoint Analysis Techniques to Investigate Patients' Preferences Regarding Osteoarthritis Treatment. Patient Prefer Adherence 2021; 15:197-211. [PMID: 33568897 PMCID: PMC7868222 DOI: 10.2147/ppa.s287322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The use of conjoint analysis (CA) to elicit patients' preferences for osteoarthritis (OA) treatment has the potential to contribute to tailoring treatments and enhancing patients' compliance and adherence. This review's main aim was to identify and summarise the evidence that used conjoint analysis techniques to quantify patient preferences for OA treatments. METHODS A comprehensive search strategy was conducted using electronic databases and hand reference checks. Databases were searched from their inception until 10th June 2019. All OA and CA related terms were used to conduct the search. The authors reviewed the papers and used the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) checklist to assess the quality of the included studies. RESULTS The search identified 534 records. Sixteen records were selected for full-text review and quality assessment and all were included in the narrative data synthesis. All included studies suggested that the severity of symptoms influenced the patients' preference for OA treatment. All included studies recognised CA as a useful method to investigate patients' preferences concerning OA treatment. CONCLUSION Patients preference for OA treatment is driven by the severity of patients' symptoms and the desire to avoid treatment side effects and CA is a useful tool to investigate patients' preferences for OA treatment.
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Affiliation(s)
- Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Correspondence: Basem Al-Omari College of Medicine and Health Sciences, Khalifa University, PO Box 127788, Abu Dhabi, United Arab EmiratesTel +971 28109807 Email
| | - Peter McMeekin
- School of Health and Life Science, University of Northumbria, Newcastle-Upon-Tyne, UK
| | - Angela Bate
- School of Health and Life Science, University of Northumbria, Newcastle-Upon-Tyne, UK
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74
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Eliciting Preferences for HIV Prevention Technologies: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:151-174. [PMID: 33319339 PMCID: PMC7884379 DOI: 10.1007/s40271-020-00486-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/10/2023]
Abstract
Background Many human immunodeficiency virus (HIV) prevention technologies (pre-exposure prophylaxis, microbicides, vaccines) are available or in development. Preference elicitation methods provide insight into client preferences that may be used to optimize products and services. Given increased utilization of such methods in HIV prevention, this article identifies and reviews these methods and synthesizes their application to HIV prevention technologies. Methods In May 2020, we systematically searched peer-reviewed literature in PubMed, CINAHL, and Web of Science for studies employing quantitative preference elicitation methods to measure preferences for HIV prevention technologies among populations of any age, sex, or location. Quality assessment used an existing checklist (PREFS) and a novel adaptation of the Newcastle–Ottawa Scale (PROSPERO #CRD42018087027). Results We screened 5022 titles and abstracts, reviewed 318 full texts, and included 84 studies. Common methods employed were discrete-choice experiment (33%), conjoint analysis (25%), and willingness-to-participate/try/accept (21%). Studies were conducted in 25 countries and had a mean of 768 participants (range = 26–7176), two-thirds of them male. Common HIV prevention technologies included pre-exposure prophylaxis (23%), voluntary testing and counseling (19%), HIV self-testing (17%), vaccines (15%), and topical microbicides (9%). Most attributes focused on product design (side effects, frequency), service design (provider type, location), acceptability or willingness to accept/pay; results are summarized in these categories, by prevention type. Mean quality-adapted Newcastle–Ottawa Scale score was 4.5/8 (standard deviation = 2.1) and mean PREFS scores was 3.47/5 (standard deviation = 0.81). Conclusions This review synthesizes extant literature on quantitative measurement of preferences for HIV prevention technologies. This can enable practitioners to improve prevention products and interventions, and ultimately reduce HIV incidence.
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Abstract
This study introduces e-mobility for humanitarian purposes and presents the first investigation of innovative e-mobility transport solutions (e.g., e-bike, e-stretcher, and drone) for mountain rescue. In practice, it is largely unclear which e-mobility transport solutions might be suitable and what selection attributes are to be considered. The subsequent study supports the technology selection process by identifying and measuring relevant selection attributes to facilitate the adoption of e-mobility in this domain. For the purpose of this study, a multi-method research approach that combines qualitative and quantitative elements was applied. In the first step, results of a systematic search for attributes in literature were combined with inputs gained from unstructured expert interviews and discussions. The perceived importance of the identified selection attributes was then measured by analyzing survey data of 341 rescue workers using the best-worst scaling methodology. Finally, the results were reiterated in another expert discussion to assess their overall validity. Study results indicate that e-mobility transport solutions need to primarily enhance operational performance and support the safety of mountain rescue personnel. Surprisingly, economic and sustainability aspects are less of an issue in the process of technology selection.
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76
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Xu RH, Zhou L, Wong ELY, Wang D, Xiang GC, Xu C. A best-worst scaling survey of medical students' perspective on implementing shared decision-making in China. BMC MEDICAL EDUCATION 2020; 20:486. [PMID: 33267806 PMCID: PMC7709333 DOI: 10.1186/s12909-020-02406-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The objective of this study was to ascertain the importance rankings of factors affecting the implementation of shared decision-making (SDM) in medical students in China and determine whether these factors were consistent across the respondents' individual characteristics. METHOD Students studying clinical medicine were recruited from three medical universities in China. A cross-sectional online survey using best-worst object scaling with a balanced incomplete block design was adopted to investigate their preference towards implementing SDM in China. Count analysis, multinomial logit analysis and mixed logit analysis were used to estimate the preference heterogeneity of the SDM factors among respondents. RESULTS A total of 574 medical students completed the online survey. The three most important factors for implementing SDM were trust and respect, (providing) high-quality medical information and multi-disciplinary collaboration. The mixed logit regression model identified significant heterogeneity in SDM preferences among respondents, and sub-group analysis showed that some heterogeneities varied in respondents by sex, study programs and their experience of visiting doctors. CONCLUSION The importance rankings provide rich information for implementing SDM and facilitate the reform of education in medical schools in China. However, the heterogeneities in SDM preference need further explorations.
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Affiliation(s)
- Richard Huan Xu
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lingming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China.
| | - Guo Chun Xiang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Chao Xu
- Graduate School, Southern Medical University, Guangzhou, China
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77
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Saadati H, Baradaran HR, Danaei G, Ostovar A, Hadaegh F, Janani L, Steyerberg EW, Khalili D. Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease. BMC Med Inform Decis Mak 2020; 20:288. [PMID: 33148227 PMCID: PMC7640674 DOI: 10.1186/s12911-020-01304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are. METHODS We conducted a preference-eliciting survey incorporating a best-worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design. RESULTS According to the mean (SD) BWS scores, which can be (+ 4) in maximum and (- 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (- 3. 03 (1.03)), nausea/headache (- 2.69 (0.94)), and treatment discontinuation due to side effects (- 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals. CONCLUSION The rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.
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Affiliation(s)
- Hassan Saadati
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. .,Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition University of Aberdeen, Aberdeen, UK. .,Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Murray J, Lynch Y, Goldbart J, Moulam L, Judge S, Webb E, Jayes M, Meredith S, Whittle H, Randall N, Meads D, Hess S. The decision-making process in recommending electronic communication aids for children and young people who are non-speaking: the I-ASC mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
This project [Identifying Appropriate Symbol Communication (I-ASC)] explored UK decision-making practices related to communication aid recommendations for children and young people who are non-speaking. Research evidence related to communication aid decision-making is limited. The research aims were to increase understanding of influencers on the decision-making process in recommending electronic communication aids, and to develop guidance tools to support decision-making. An additional, post hoc aim was to evaluate the public involvement contribution to the I-ASC project. The research focused on the identification of attributes and characteristics that professionals, family members and those who use communication aids considered important in the recommendation process. Findings informed the development of guidance resources. The evaluation of public involvement focused on what could be learned from a nationally funded project with involvement from public contributors typically regarded as hard to include.
Methodology
For the clinical decision-making component, the methodological investigation adopted a three-tier approach with three systematic reviews, a qualitative exploration of stakeholder perspectives through focus groups and interviews, and a quantitative investigation surveying professionals’ perspectives. The public involvement evaluation adopted a mixed-methods approach. A total of 354 participants contributed to the decision-making data set, including professionals, family members, and children, young people and adults who use communication aids; 22 participants contributed to the public involvement evaluation. The literature review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thematic analysis and framework approach supported the analysis of qualitative data. Two stated preference surveys, a best–worst scaling and a discrete choice experiment, allowed the relative importance of factors in decision-making to be determined. Analysis was grounded in random utility theory.
Public involvement
Two public involvement co-researchers, an adult using a symbol communication aid and a parent of a communication aid user, were core members of the research team. The I-ASC public involvement resulted in an additional award to evaluate the impact of public involvement across the project.
Results
Factors influencing decision-making are not always under the control of the decision-makers, for example professional knowledge, referral criteria and service structure. Findings suggest that real clinical decisions contrast with hypothetical decisions. Survey responses indicated that children’s physical characteristics are less important than their language, communication and learning abilities; however, during real-time decision-making, the opposite appeared to be true, with access needs featuring most prominently. In contrast to professionals’ decisions, users and family members prioritise differing aesthetic attributes of communication aids. Time allocated to system learning remains underspecified. The research informed the development of decision-making guidance tools (https://iasc.mmu.ac.uk/; accessed 8 June 2020). A public involvement evaluation suggests that successful public involvement of individuals with disabilities requires significant resources that include staff time, training and personal support (https://iasc.mmu.ac.uk/publicinvolvement; accessed 8 June 2020).
Future work
Further research is needed in the areas of language assessment, communication aid attributes, types of decision-making episodes and service user perspectives. These data highlight the need for mechanisms that enable public involvement co-researchers to be paid for their contributions to research bid preparation.
Limitations
Individuals who benefit from communication aids are a heterogeneous group. We cannot guarantee that this study has captured all relevant components of decision-making.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Janice Murray
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Yvonne Lynch
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Juliet Goldbart
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Liz Moulam
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Simon Judge
- Barnsley Assistive Technology Service, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Edward Webb
- Leeds Institute of Health Sciences and Choice Modelling Centre, University of Leeds, Leeds, UK
| | - Mark Jayes
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Stuart Meredith
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Helen Whittle
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Nicola Randall
- Barnsley Assistive Technology Service, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - David Meads
- Leeds Institute of Health Sciences and Choice Modelling Centre, University of Leeds, Leeds, UK
| | - Stephane Hess
- Choice Modelling Centre and Institute of Transport Studies, University of Leeds, Leeds, UK
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Hettiarachchi R, Kularatna S, Byrnes J, Mulhern B, Chen G, Scuffham PA. Valuation study for a preference-based quality of life measure for dental caries (Dental Caries Utility Index - DCUI) among Australian adolescents - study protocol. BMJ Open 2020; 10:e038626. [PMID: 33087374 PMCID: PMC7580066 DOI: 10.1136/bmjopen-2020-038626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A new health state classification system has been developed for dental caries - Dental Caries Utility Index (DCUI) to facilitate the assessment of oral health interventions in the cost-utility analysis (CUA). This paper reports the protocol for a valuation study, which aims to generate a preference-based algorithm for the classification system for the DCUI. METHODS AND ANALYSIS Discrete choice experiments (DCEs) will be conducted to value health states generated by the DCUI classification system and preferences for these health states will be modelled to develop a utility algorithm. DCEs produce utility values on a latent scale and these values will be anchored into the full health-dead scale to calculate the quality-adjusted life years in CUA. There is no previous evidence for the most suitable anchoring method for dental caries health state valuation. Hence, we will first conduct pilot studies with two anchoring approaches; DCE including duration attribute and DCE anchoring to worst heath state in Visual Analogue Scale. Based on the pilot studies, the most suitable anchoring method among two approaches will be used in the main valuation survey, which will be conducted as an online survey among a representative sample of 2000 adults from the Australian general population. Participants will be asked to complete a set of DCE choice tasks along with anchoring tasks, basic social-demographic questions, DCUI, a generic preference-based measure and oral health quality of life instrument. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Human Research Ethics Committee, Griffith University (reference number HREC/2019/550). The generated algorithm will facilitate the use of the new dental caries preference-based measure in economic evaluations of oral health interventions. The results will be disseminated through journal articles and professional conferences.
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Affiliation(s)
- Ruvini Hettiarachchi
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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80
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Naunheim MR, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences. Otolaryngol Head Neck Surg 2020; 164:473-481. [PMID: 32895002 DOI: 10.1177/0194599820950723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences. DATA SOURCES Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology. REVIEW METHODS Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the "Evidence-Based Medicine in Otolaryngology" series focuses on formal assessment of patient preferences and the optimal methods to determine them. CONCLUSIONS Methods have been developed to optimize our understanding of patient preferences. IMPLICATIONS FOR PRACTICE Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Leclercq V, Hiligsmann M, Parisi G, Beaudart C, Tirelli E, Bruyère O. Best-worst scaling identified adequate statistical methods and literature search as the most important items of AMSTAR2 (A measurement tool to assess systematic reviews). J Clin Epidemiol 2020; 128:74-82. [PMID: 32827628 DOI: 10.1016/j.jclinepi.2020.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the relative importance of A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2) items. STUDY DESIGN AND SETTING A best-worst scaling object case was conducted among a sample of experts in the field of systematic reviews (SRs) and meta-analyses (MAs). Respondents were asked in a series of 15 choice tasks to choose the most and the least important item from a set of four items from the master list, which included the 16 AMSTAR2 items. Hierarchical Bayes analysis was used to generate the relative importance score for each item. RESULTS The most important items highlighted by our 242 experts to conduct overview of reviews and critically assess SRs/MAs were the appropriateness of statistical analyses and adequacy of the literature search, followed by items regarding the assessment of risk of bias, the research protocol, and the assessment of heterogeneity (relative importance score >6.5). Items related to funding sources and the assessment of study selection and data extraction in duplicate were rated as least important. CONCLUSION Although all AMSTAR2 items can be considered as important, our results highlighted the importance of keeping the two items (the appropriateness of statistical analyses and the adequacy of the literature search) among the critical items proposed by AMSTAR2 to critically appraise SRs/MAs.
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Affiliation(s)
- Victoria Leclercq
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing.; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands.
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Gianni Parisi
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing
| | - Ezio Tirelli
- Department of Psychology, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing
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Webb EJD, Meads D, Al-Janabi H, Kind P, Torelli F, Horton M, Oyebode J, Wright P. UK General Population Utility Values for the SIDECAR-D Instrument Measuring the Impact of Caring for People With Dementia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1079-1086. [PMID: 32828221 PMCID: PMC7456787 DOI: 10.1016/j.jval.2020.04.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/26/2019] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Dementia affects many people, with numbers expected to grow as populations age. Many people with dementia receive informal/family/unpaid care, for example, from a spouse or child, which may affect carer quality of life. Measuring the effectiveness of health/social care interventions for carers requires a value measure of the quality-of-life impact of caring. This motivated development of the Scales Measuring the Impact of Dementia on Carers-D (SIDECAR-D) instrument. This study aimed to obtain general population values for SIDECAR-D to aid incorporating the impact of caring in economic evaluation. METHODS Members of the UK general public completed a best-worst scaling object case survey, which included the 18 SIDECAR-D items and EQ-5D-3L descriptions. Responses were analyzed using scale-adjusted finite mixture models. Relative importance scores (RISs) for the 18 SIDECAR-D items formed the SIDECAR-D relative scale measuring the relative impact of caring. The SIDECAR-D tariff, on the full health = 1, dead = 0 scale, was derived by rescaling EQ-5D-3L and SIDECAR-D RISs so the EQ-5D-3L RISs equaled anchored valuations of the EQ-5D-3L pits state from a visual analog scale task. RESULTS Five hundred ten respondents completed the survey. The model had 2 parameter and 3 scale classes. Additive utility decrements of SIDECAR-D items ranged from -0.05 to -0.162. Utility scores range from 0.95 for someone affirming 1 item to -0.297 for someone affirming all 18. CONCLUSION SIDECAR-D is a needs-based scale of the impact on quality of life of caring for someone with dementia, with a valuation tariff to support its use in economic evaluation.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Hareth Al-Janabi
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, UK
| | - Paul Kind
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Francesca Torelli
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Mike Horton
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, England, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK
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Yemeke TT, Kiracho EE, Mutebi A, Apolot RR, Ssebagereka A, Evans DR, Ozawa S. Health versus other sectors: Multisectoral resource allocation preferences in Mukono district, Uganda. PLoS One 2020; 15:e0235250. [PMID: 32730256 PMCID: PMC7392331 DOI: 10.1371/journal.pone.0235250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To elicit citizen preferences for national budget resource allocation in Uganda, examine respondents’ preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations. Methods We surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens’ preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents’ preferences with actual government budget allocations. Results The health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents’ preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents’ preferences. Conclusions Among respondents from Mukono district in Uganda, we found that citizens’ preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents’ strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens’ needs and preferences, but also to meet the government’s health goals to improve health, strengthen health systems, and achieve universal health coverage.
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Affiliation(s)
- Tatenda T. Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Elizabeth E. Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Rebecca R. Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Daniel R. Evans
- Duke University School of Medicine, Durham, NC, United States of America
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- * E-mail:
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Mishra MV, Thayer WM, Janssen E, Hoppe B, Eggleston C, Bridges JFP. Patient preferences for reducing bowel adverse events following prostate radiotherapy. PLoS One 2020; 15:e0235616. [PMID: 32639983 PMCID: PMC7343167 DOI: 10.1371/journal.pone.0235616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Extended Prostate Cancer Index Composite (EPIC) instrument is a commonly used patient reported outcome (PRO) tool in prostate cancer clinical trials. Summary scores for EPIC subscales are calculated by averaging patient scores for attributes (e.g., side effects), implying equal weighting of the attributes in the absence of evidence showing otherwise. METHODS We estimated patient preferences for each of the attributes included in the bowel subscale of the EPIC instrument using best-worst (B-W) scaling among a cohort of men with prostate cancer. Patients were presented with multiple tasks in which they were asked to indicate which attribute they would find most and least bothersome at different levels of severity. Analysis utilized both (simple) B-W counts and scores to estimate patient preferences for each attribute as well as attribute levels. RESULTS A total of 174 respondents from two institutions participated in the survey. Preference estimates for each of the five attributes included in the EPIC-26 bowel subscale showed wide variation preferences: 'losing control of bowel movements' was found to be the most bothersome attribute, with a B-W score of -0.48, followed by bowel urgency which also had negative B-W score (-0.04). Increased frequency of bowel movements was the least bothersome attribute, with a B-W score of +0.33, followed by bloody stools (+0.12), and pelvic/rectal pain (+0.06). Analysis of preference weights for attribute bother levels showed preference estimates be linear. CONCLUSIONS We provide novel evidence on patient preferences for side effect reduction following prostate radiotherapy. Within the bowel sub-scale of the EPIC-26 short form, we found that bowel incontinence was perceived to be the most bothersome treatment effect, while increased bowel frequency was least bothersome to patients.
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Affiliation(s)
- Mark V. Mishra
- Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, MD, United States of America
- * E-mail:
| | - Winter Maxwell Thayer
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Ellen Janssen
- Center for Medical Technology Policy, Baltimore, MD, United States of America
| | - Bradford Hoppe
- Department of Radiation Oncology, Mayo Clinic-Florida, Tampa, FL, United States of America
| | - Caitlin Eggleston
- Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, MD, United States of America
| | - John F. P. Bridges
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States of America
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Nyabinwa P, Kashongwe OB, Hirwa CD, Bebe BO. Perception of farmers about endometritis prevention and control measures for zero-grazed dairy cows on smallholder farms in Rwanda. BMC Vet Res 2020; 16:175. [PMID: 32503530 PMCID: PMC7275537 DOI: 10.1186/s12917-020-02368-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endometritis is a prevalent uterine disease in postpartum cows. The disease reduces fertility performance and milk yield, and subsequently, productivity and profitability of dairy farms. The reduction in performance is associated with considerable economic losses on dairy farms. Smallholder farmers are likely to incur considerable economic losses from the disease where they lack knowledge of effective prevention and control measures for the disease. This study used farmer's perspectives to determine the effectiveness of different management interventions (MIs) for endometritis prevention and control on smallholder farms in Rwanda practicing dairy zero-grazing. The best-worst scaling (BWS) choice method was applied that relied on past 1 year recall data obtained from 154 farmers. These farmers were identified through snowball sampling in a cross-sectional study. RESULTS Of the 20 MIs evaluated, 12 scored highly for effectiveness. The top four most effective are: avoiding sharing equipment with neighbouring farms (45.5%), consulting animal health service provider about disease treatment (31.8%), keeping cows in a clean and dry shed (26.7%), and selecting sires based on calving ease (26.6%). The MIs considered least effective were: maintaining clean transition cow housing (35.1%), removal of fetal membrane immediately after passing (33.1%), disinfecting the equipment used in calving assistance before and after use (32.5%), and selecting sires with low percent stillbirths (29.2%). CONCLUSION This study has demonstrated the application of BWS object case method in understanding the MIs that farmers consider are most effective in the prevention and control of endometritis disease in the dairy herds. The MIs are on-farm biosecurity and hygiene, seeking veterinary services for disease treatment and selecting sires for ease of calving. These MIs should be considered for prioritization in extension services and research to continuously improve and enhance their practical application on smallholder dairy farms.
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Affiliation(s)
- Pascal Nyabinwa
- Rwanda Agriculture and Animal Resources Development Board, P.O; Box 5016, Kigali, Rwanda.
- Department of Animal Sciences, Faculty of Agriculture, Egerton University, P.O; Box 536, Egerton, Kenya.
| | - Olivier Basole Kashongwe
- Department of Animal Sciences, Faculty of Agriculture, Egerton University, P.O; Box 536, Egerton, Kenya
| | - Claire d'Andre Hirwa
- Rwanda Agriculture and Animal Resources Development Board, P.O; Box 5016, Kigali, Rwanda
| | - Bockline Omedo Bebe
- Department of Animal Sciences, Faculty of Agriculture, Egerton University, P.O; Box 536, Egerton, Kenya
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Aschmann HE, Boyd CM, Robbins CW, Chan WV, Mularski RA, Bennett WL, Sheehan OC, Wilson RF, Bayliss EA, Leff B, Armacost K, Glover C, Maslow K, Mintz S, Puhan MA. Informing Patient-Centered Care Through Stakeholder Engagement and Highly Stratified Quantitative Benefit-Harm Assessments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:616-624. [PMID: 32389227 DOI: 10.1016/j.jval.2019.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 11/01/2019] [Accepted: 11/16/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In a previous project aimed at informing patient-centered care for people with multiple chronic conditions, we performed highly stratified quantitative benefit-harm assessments for 2 top priority questions. In this current work, our goal was to describe the process and approaches we developed and to qualitatively glean important elements from it that address patient-centered care. METHODS We engaged patients, caregivers, clinicians, and guideline developers as stakeholder representatives throughout the process of the quantitative benefit-harm assessment and investigated whether the benefit-harm balance differed based on patient preferences and characteristics (stratification). We refined strategies to select the most applicable, valid, and precise evidence. RESULTS Two processes were important when assessing the balance of benefits and harms of interventions: (1) engaging stakeholders and (2) stratification by patient preferences and characteristics. Engaging patients and caregivers through focus groups, preference surveys, and as co-investigators provided value in prioritizing research questions, identifying relevant clinical outcomes, and clarifying the relative importance of these outcomes. Our strategies to select evidence for stratified benefit-harm assessments considered consistency across outcomes and subgroups. By quantitatively estimating the range in the benefit-harm balance resulting from true variation in preferences, we clarified whether the benefit-harm balance is preference sensitive. CONCLUSIONS Our approaches for engaging patients and caregivers at all phases of the stratified quantitative benefit-harm assessments were feasible and revealed how sensitive the benefit-harm balance is to patient characteristics and individual preferences. Accordingly, this sensitivity can suggest to guideline developers when to tailor recommendations for specific patient subgroups or when to explicitly leave decision making to individual patients and their providers.
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Affiliation(s)
- Hélène E Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Craig W Robbins
- Center for Clinical Information Services, Kaiser Permanente Care Management Institute, Oakland, CA, USA; Kaiser Permanente National Guideline Program, Oakland, CA, USA; Colorado Permanente Medical Group, Denver, CO, USA; Guidelines International Network, Board of Trustees, Denver, CO, USA; Permanente Federation, Clinical Education MOC Portfolio, Oakland, CA, USA
| | - Wiley V Chan
- Kaiser Permanente Northwest National Guideline Program, Portland, OR, USA
| | - Richard A Mularski
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; Department of Pulmonary & Critical Care Medicine, Northwest Permanente, Portland, OR, USA; Oregon Health & Science University, Portland, OR, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renée F Wilson
- Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Bayliss
- Institute for Research Health, Kaiser Permanente, Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Armacost
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol Glover
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Maslow
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Gerontological Society of America, Washington, DC, USA
| | - Suzanne Mintz
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Family Caregiver Advocacy, Kensington, MD, USA
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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Kim HY, Hanrahan CF, Dowdy DW, Martinson NA, Golub JE, Bridges JF. Priorities among HIV-positive individuals for tuberculosis preventive therapies. Int J Tuberc Lung Dis 2020; 24:396-402. [PMID: 32317063 PMCID: PMC7518293 DOI: 10.5588/ijtld.18.0740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: There has been slow uptake of isoniazid preventive therapy (IPT) among people living with HIV (PLWH).METHODS: We surveyed adults recently diagnosed with HIV in 14 South African primary health clinics. Based on the literature and qualitative interviews, sixteen potential barriers and facilitators related to preventive therapy among PLWH were selected. Best-worst scaling (BWS) was used to quantify the relative importance of the attributes. BWS scores were calculated based on the frequency of participants' selecting each attribute as the best or worst among six options (across multiple choice sets) and rescaled from 0 (always selected as worst) to 100 (always selected as best) and compared by currently receiving IPT or not.RESULTS: Among 342 patients surveyed, 33% (n = 114) were currently taking IPT. Having the same standard of life as someone without HIV was most highly prioritized (BWS score = 67.3, SE = 0.6), followed by trust in healthcare providers (score, 66.3 ± 0.6). Poor standard of care in public clinics (score, 30.6 ± 0.6) and side effects of medications (score, 33.7 ± 0.6) were least prioritized. BWS scores differed by IPT status for few attributes, but overall ranking was similar (spearman's rho = 0.9).CONCLUSION: Perceived benefits of preventive therapy were high among PLWH. IPT prescription by healthcare providers should be encouraged to enhance IPT uptake among PLWH.
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Affiliation(s)
- Hae-Young Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP)
| | - Colleen F. Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil A. Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan E. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - John F.P. Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
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Assessing physician preferences on future therapeutic options and diagnostic practices in non-alcoholic steatohepatitis. JHEP Rep 2020; 2:100081. [PMID: 32190823 PMCID: PMC7068123 DOI: 10.1016/j.jhepr.2020.100081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background & Aims There is currently no data on physician preferences regarding future therapies for non-alcoholic steatohepatitis (NASH); this study explores these preferences and characteristics that are relevant to physician decision-making when choosing a potential therapy for a patient with NASH. The results were compared with those from a similar patient preference survey which was conducted in parallel. Method Initial exploratory 30-minute telephone interviews were conducted to inform the design of a 15-minute quantitative online specialist physicians survey, containing direct questions and a preference survey. This was based on a best-worst scaling (BWS) experiment to assess the relative importance of different treatment characteristics (attributes), followed by several paired comparison questions to understand the preference for 5 hypothetical product profiles. Results The answers come from 121 physicians from Canada (n = 31), Germany (n = 30), the UK (n = 30) and the USA (n = 30). The primary driving element in NASH treatment decision-making was efficacy (49.23%), defined as "[hypothetical product] impact on liver status" and "[slowing of] progression to cirrhosis". Physicians reported the common use of non-invasive NASH diagnostic tests and 81% reported performing liver biopsy. In 57% of cases, physicians reported that "concerns related to the available diagnostic methods" limit the number of patients with biopsy-confirmed NASH. Conclusions This first physician preference study reveals that efficacy will be the main driver for physicians in selecting future NASH drugs. The findings also confirm the widespread use of non-invasive diagnostic tests and the reluctance to perform confirmatory liver biopsy despite guideline recommendations, mainly due to limited therapeutic options and patient refusal. Lay summary This study explores physician preferences in relation to future therapies for non-alcoholic steatohepatitis (NASH) and characteristics that are relevant to physician decision-making when choosing a potential therapy for a patient with NASH. The results of a short online survey completed by 121 specialist physicians determined that the primary factor that influences treatment decision-making is efficacy, and that a wide range of non-invasive techniques are used to diagnose NASH, while confirmatory liver biopsy is not performed by all physicians despite guideline recommendations.
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Huybers T, Greene B, Rohr DH. Academic research integrity: Exploring researchers’ perceptions of responsibilities and enablers. Account Res 2020; 27:146-177. [DOI: 10.1080/08989621.2020.1732824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Bronwyn Greene
- Division of Academic Conduct & Integrity, UNSW – Sydney, Australia
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Consumer Perception of Online Attributes in Circular Economy Activities. SUSTAINABILITY 2020. [DOI: 10.3390/su12051914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Businesses like Airbnb have shown that a successful circular economy (CE) business can operate exclusively online. Although online communication and web appearance attributes have been subject to academic research given accelerated digitization, there is still a lack of knowledge about online attributes and their role in facilitating CE. We close the portrayed knowledge gap by conducting a discrete-choice experiment with best to worst scaling and focusing on the effect of CE experience on the perception of a CE website by ranking nine online attributes, grouped in three subsets. We therefore contribute by identifying online attributes that are perceived as favorable for CE businesses and detect how participation in CE activities affects the perception of these attributes. We find that third-party associated online attributes (e.g., user reviews or third-party guarantees) rank significantly higher throughout CE consumption patterns of the sample, being always amongst the top three attributes. This novel finding on online preferences opens a new direction for further research, as well as allows practitioners to optimize online operations accordingly. Furthermore, we find that users without prior touchpoints with CE have a higher need for information about the business model as compared to CE active users who are more interested in community related attributes.
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Abstract
PURPOSE OF REVIEW The current review highlights the growing number of available methods used to measure patient preferences and discusses how this impacts preference research in rheumatology. Spurred by the growing role of preferences in regulatory decisions and drug development, researchers have begun applying preference methods to study questions beyond the clinical context. We explore these trends, provide case studies highlighting changes in measuring patient preferences, compare strengths and weaknesses of common stated-preference methods, and discuss considerations for the future use of these methods. RECENT FINDINGS Early literature on patient preferences often mimicked clinical practice, asking whether treatment A is better or worse than treatment B for a patient. Early applications of patient preference methods in rheumatology aimed to value different attributes of treatments, but remained focused on informing clinical questions. Spurred by interest in preferences by regulatory agencies and patient-centeredness throughout the product lifecycle, there are now a wide array of methods available to measure preference. SUMMARY Although these different preference methods have strengths and weaknesses, they serve to highlight the broad number of questions that could help rheumatology beyond the clinical context. Researchers in rheumatology now have the opportunity to better serve diverse stakeholders by considering how these methods could aid in clinical trial design, regulatory policy, and other elements of the medical product life cycle.
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Visser LA, Louapre C, Uyl-de Groot CA, Redekop WK. Patient needs and preferences in relapsing-remitting multiple sclerosis: A systematic review. Mult Scler Relat Disord 2020; 39:101929. [PMID: 31924590 DOI: 10.1016/j.msard.2020.101929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 01/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Considering the multiple treatments approved for multiple sclerosis (MS) by the Food and Drug Administration (FDA) and European Medicines Agency (EMA), determining a treatment strategy for patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) can be challenging. To date, an overview of the needs and preferences of patients at each treatment decision-making moment is lacking. Therefore, the aim of this systematic review is to examine the existing literature about the needs and preferences of patients with CIS and RRMS when making treatment decisions. METHODS A systematic search was done using Embase, Medline, PsychINFO, Web of Science and Google Scholar. Eligibility criteria included whether the article described a study of adults with CIS/RRMS and reported patient needs or preferences regarding first-line disease modifying treatment (DMT) decisions. Publications were categorized by treatment decision: initiation of first DMT (D1), DMT adherence/discontinuation (D2a/D2b), and switch to a second DMT (D3). A separate category was created for stated preference studies such as discrete choice experiment methods to examine the relative importance of different treatment attributes. Publications were compared to identify key factors. RESULTS The search yielded 2789 articles after removal of duplicates and 434 full-text publications were reviewed for eligibility. Twenty-four articles fulfilled all criteria: n = 5 (D1), n = 12 (D2a), n = 13 (D2b), and n = 3 (D3); six articles studied more than one treatment decision. The need for social support is important during D1. The most commonly reported reasons for adherence/discontinuation/switch included forgetfulness, side-effects, and injection-related reasons. Eight articles described preference studies; the most important DMT attributes were efficacy, mode and frequency of administration, and side-effect profile. CONCLUSIONS Understanding the needs and preferences of CIS/RRMS patients regarding DMT attributes and non-treatment related attributes are important to improve treatment decision-making and reduce non-adherence. Studies are needed to understand patient preferences upon treatment initiation. Furthermore, preference studies should include attributes based on the patient perspective.
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Affiliation(s)
- L A Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
| | - C Louapre
- Institut du Cerveau et de la Moelle épinière - ICM, Groupe hospitalier Pitié-Salpêtrière, 47-83, bd de l'Hôpital. 75651 Paris CEDEX 13, France.
| | - C A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
| | - W K Redekop
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
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Li T, Le JT, Hays RD, Cui QN, Eydelman M, Spaeth G, Tarver ME, Singh K. Patient-reported outcomes measures and patient preferences for minimally invasive glaucoma surgical devices. Eye (Lond) 2020; 34:205-210. [PMID: 31772384 PMCID: PMC7002517 DOI: 10.1038/s41433-019-0676-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Many therapeutic options are available to glaucoma patients. One recent therapeutic option is minimally invasive glaucoma surgical (MIGS) devices. It is unclear how patients view different treatments and which patient-reported outcomes would be most relevant in patients with mild to moderate glaucoma. We developed a questionnaire for patients eligible for MIGS devices and a patient preference study to examine the value patients place on certain outcomes associated with glaucoma and its therapies. OBJECTIVES To summarize the progress to date. METHODS Questionnaire development: We drafted the questionnaire items based on input from one physician and four patient focus groups, and a review of the literature. We tested item clarity with six cognitive interviews. These items were further refined. Patient preference study: We identified important benefit and risk outcomes qualitatively using semi-structured, one-on-one interviews with patients who were eligible for MIGS devices. We then prioritized these outcomes quantitatively using best-worst scaling methods. RESULTS Questionnaire testing: Three concepts were deemed relevant for the questionnaire: functional limitations, symptoms, and psychosocial factors. We will evaluate the reliability and validity of the 52-item draft questionnaire in an upcoming field test. Patient preference study: We identified 13 outcomes that participants perceived as important. Outcomes with the largest relative importance weights were "adequate IOP control" and "drive a car during the day." CONCLUSIONS Patients have the potential to steer clinical research towards outcomes that are important to them. Incorporating patients' perspectives into the MIGS device development and evaluation process may expedite innovation and availability of these devices.
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Affiliation(s)
- Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Denver, Aurora, CO, USA.
| | - Jimmy T Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ronald D Hays
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Qi N Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Malvina Eydelman
- Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices, Center for Devices and Radiological Health, United States Food and Drug Administration, White Oak, MD, USA
| | - George Spaeth
- Wills Eye Hospital, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michelle E Tarver
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, United States Food and Drug Administration, White Oak, MD, USA
| | - Kuldev Singh
- Stanford University School of Medicine, Stanford, CA, USA
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94
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Factors that influence patient acceptance of clinical pharmacy services: A nationwide survey. J Am Pharm Assoc (2003) 2020; 60:1058-1067.e4. [PMID: 32962899 PMCID: PMC9840879 DOI: 10.1016/j.japh.2020.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/21/2020] [Accepted: 08/28/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Examine the factors that influence a patient's likelihood of participating in clinical pharmacy services so that pharmacists can use this knowledge to effectively expand clinical services. METHODS An online survey was distributed to U.S. citizens 55 years of age or older through a market research company. The survey assessed pharmacy and medication use, general health, interest in clinical pharmacy services, and general demographics. The specific clinical services examined included medication therapy management (MTM) and a collaborative practice agreement (CPA). Logistic regression and best-worst scaling were used to predict the likelihood of participating and determine the motivating factors to participate in clinical pharmacy services, respectively. RESULTS Two hundred eight (58.45%) respondents reported being likely to participate in MTM services, and 108 (50.6%) reported being likely to participate in the services offered by a pharmacist with a CPA, if offered. The motivations to participate in MTM were driven by pharmacist management of medication interactions and adverse effects (best-worst scores 0.62 and 0.51, respectively). The primary motivator to participate in a CPA was improved physician-pharmacist coordination (best-worst score 0.80). Those with a personal pharmacist were more likely to participate in MTM (odds ratio [OR] 2.43 [95% CI 1.41-4.22], P = 0.002) and a pharmacist CPA (2.08 [1.26-3.44], P = 0.004). Previous experience with MTM increased the likelihood of participating again in MTM (5.98 [95% CI 2.50-14.35], P < 0.001). Patient satisfaction with the pharmacy increased the likelihood of participating in a pharmacist CPA (1.47 [95% CI 1.01-2.13], P = 0.04). CONCLUSION Patients are interested in clinical pharmacy services for the purposes of medication interaction management, adverse effect management, and improved physician-pharmacist coordination. The factors that influenced the likelihood of participating included having a personal pharmacist, previous experience with MTM, and pharmacy satisfaction. These results suggest a potential impact of the patient-pharmacist relationship on patient participation in clinical services.
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95
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Pitt SC, Lee CN. Medical Decision-Making Research in Surgery. Health Serv Res 2020. [DOI: 10.1007/978-3-030-28357-5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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96
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Reporting Formative Qualitative Research to Support the Development of Quantitative Preference Study Protocols and Corresponding Survey Instruments: Guidelines for Authors and Reviewers. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 13:121-136. [DOI: 10.1007/s40271-019-00401-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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97
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Batchelder L, Malley J, Burge P, Lu H, Saloniki EC, Linnosmaa I, Trukeschitz B, Forder J. Carer Social Care-Related Quality of Life Outcomes: Estimating English Preference Weights for the Adult Social Care Outcomes Toolkit for Carers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1427-1440. [PMID: 31806200 DOI: 10.1016/j.jval.2019.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 07/01/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is increasing interest in assessing the effects of interventions on older people, people with long-term conditions and their informal carers for use in economic evaluation. The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) is a measure that specifically assesses the impact of social care services on informal carers. To date, the ASCOT-Carer has not been preference-weighted. OBJECTIVES To estimate preference-based index values for the English version of the ASCOT-Carer from the general population in England. METHODS The ASCOT-Carer consists of 7 domains, each reflecting aspects of social care-related quality of life in informal carers. Preferences for the ASCOT-Carer social care-related quality of life states were estimated using a best-worst scaling exercise in an online survey. The survey was administered to a sample of the general adult population in England (n = 1000). Participants were asked to put themselves into the hypothetical state of being an informal carer and indicate which attribute they thought was the best (first and second) and worst (first and second) from a profile list of 7 attributes reflecting the 7 domains, each ranging at a different level (1-4). Multinomial logit regression was used to analyze the data and estimate preference weights for the ASCOT-Carer measure. RESULTS The most valued aspect by English participants was the 'occupation' attribute at its highest level. Results further showed participants rated having no control over their daily life as the lowest attribute-level of all those presented. The position of the 7 attributes influenced participants' best and worst choices, and there was evidence of both scale and taste heterogeneity on preferences. CONCLUSION This study has established a set of preference-based index values for the ASCOT-Carer in England derived from the best-worst scaling exercise that can be used for economic evaluation of interventions on older individuals and their informal carers.
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Affiliation(s)
- Laurie Batchelder
- Personal Social Services Research Unit, University of Kent, Kent, England, UK.
| | - Juliette Malley
- Personal Social Services Research Unit, London School of Economics, London, England, UK
| | | | - Hui Lu
- RAND Europe, Cambridge, UK
| | - Eirini-Christina Saloniki
- Personal Social Services Research Unit, University of Kent, Kent, England, UK; Centre for Health Services Studies, University of Kent, Kent, England, UK
| | - Ismo Linnosmaa
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland; Department of Health and Social Management, University of Eastern Finland, Finland
| | - Birgit Trukeschitz
- Research Institute for Economics of Aging, WU Vienna University of Economics and Business, Vienna, Austria
| | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Kent, England, UK
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98
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Schoenborn NL, Crossnohere NL, Bridges JFP, Pollack CE, Pilla SJ, Boyd CM. Patient Perceptions of Diabetes Guideline Frameworks for Individualizing Glycemic Targets. JAMA Intern Med 2019; 179:1642-1649. [PMID: 31524938 PMCID: PMC6749540 DOI: 10.1001/jamainternmed.2019.3806] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Diabetes guidelines recommend considering specific factors, such as diabetes duration and life expectancy, to individualize treatment in older adults. These individualized glycemic targets inform decisions on whether to intensify or deintensify medication treatment plans. How older adults with diabetes perceive these factors used to individualize glycemic targets is unknown. OBJECTIVES To examine how older adults perceive factors used in diabetes guidelines for individualizing glycemic targets. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional national survey was conducted from December 13, 2018, to January 3, 2019, of a nationally representative, probability-based online survey panel (KnowledgePanel). A total of 1364 KnowledgePanel members who were 65 years or older and had type 2 diabetes were invited to participate in the survey; 836 (61.3%) responded, and 818 (60.0%) completed the survey. MAIN OUTCOMES AND MEASURES The study randomized participants to 2 vignettes: one about adding and the other about removing diabetes medications from treatment plans. Participants rated the importance of 7 factors (diabetes duration, established diabetes complications, other health conditions, life expectancy, risk of adverse effects, cost, and treatment effort) in these treatment decisions using binary (yes/no) responses and the best-worst scaling method to quantify the factors' relative importance. All participants then answered questions on how different levels of each factor were associated with aggressiveness of diabetes treatment. RESULTS The sample included 818 participants (mean [SD] age, 74.0 [6.8] years; 469 [53.7%] male; and 668 [67.7%] white). A total of 410 participants answered questions about adding medicine, whereas 408 participants answered questions about stopping medicine. Of the 7 factors to consider for adding a diabetes medication to the treatment plan, the number who deemed each factor important ranged from 197 (45.6%) to 263 (62.8%). In contrast, these same factors were considered important by only 29 (8.4%) to 146 (37.7%) of participants when deciding to stop use of a diabetes medication. In both decisions, participants perceived the risk of adverse effects as the most important factor (relative importance was 22.8 for adding a medicine and 25.0 for stopping a medicine on a ratio scale in which, for each decision, the relative importance of the 7 factors adds up to 100, with 0 indicating complete indifference and 100 complete priority). In contrast to current guideline recommendations, most participants believed that patients with longer disease duration (498 [60.1%]), more established complications (632 [75.6%]), and greater number of other health conditions (545 [67.5%]) should receive more aggressive diabetes treatment. CONCLUSIONS AND RELEVANCE Many older adults do not place high importance on factors recommended by guidelines to individualize diabetes treatment, especially when deciding to stop use of diabetes medications. Moreover, when considering treatment aggressiveness, many older adults weighted several factors in the opposite direction than suggested by the guidelines. Individualizing diabetes care in older adults will require effective communication regarding the benefits and consequences of making changes to treatment plans.
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Affiliation(s)
- Nancy L Schoenborn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Norah L Crossnohere
- Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland.,Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia M Boyd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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99
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Schoenborn NL, Crossnohere NL, Janssen EM, Pollack CE, Boyd CM, Wolff AC, Xue QL, Massare J, Blinka M, Bridges JFP. Examining Generalizability of Older Adults' Preferences for Discussing Cessation of Screening Colonoscopies in Older Adults with Low Health Literacy. J Gen Intern Med 2019; 34:2512-2519. [PMID: 31452029 PMCID: PMC6848333 DOI: 10.1007/s11606-019-05258-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/23/2019] [Accepted: 07/09/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND/OBJECTIVES Many older adults receive unnecessary screening colonoscopies. We previously conducted a survey using a national online panel to assess older adults' preferences for how clinicians can discuss stopping screening colonoscopies. We sought to assess the generalizability of those results by comparing them to a sample of older adults with low health literacy. DESIGN Cross-sectional survey. SETTING Baltimore metropolitan area (low health literacy sample) and a national, probability-based online panel-KnowledgePanel (national sample). PARTICIPANTS Adults 65+ with low health literacy measured using a single-question screen (low health literacy sample, n = 113) and KnowledgePanel members 65+ who completed survey about colorectal cancer screening (national sample, n = 441). MEASUREMENTS The same survey was administered to both groups. Using the best-worst scaling method, we assessed relative preferences for 13 different ways to explain stopping screening colonoscopies. We used conditional logistic regression to quantify the relative preference for each explanation, where a higher preference weight indicates stronger preference. We analyzed each sample separately, then compared the two samples using Spearman's correlation coefficient, the likelihood ratio test to assess for overall differences between the two sets of preference weights, and the Wald test to assess differences in preference weights for each individual phrases. RESULTS The responses from the two samples were highly correlated (Spearman's coefficient 0.92, p < 0.0001). The most preferred phrase to explain stopping screening colonoscopy was "Your other health issues should take priority" in both groups. The three least preferred options were also the same for both groups, with the least preferred being "The doctor does not give an explanation." The explanation that referred to "quality of life" was more preferred by the low health literacy group whereas explanations that mentioned "unlikely to benefit" and "high risk for harms" were more preferred by the national survey group (all p < 0.001). CONCLUSION Among two different populations of older adults with different health literacy levels, the preferred strategies for clinicians to discuss stopping screening colonoscopies were highly correlated. Our results can inform effective communication about stopping screening colonoscopies in older adults across different health literacy levels.
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Affiliation(s)
| | - Norah L Crossnohere
- The Johns Hopkins University School of Public Health, Baltimore, MD, USA.,Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | | | - Craig E Pollack
- The Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Cynthia M Boyd
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qian-Li Xue
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | | | - Marcela Blinka
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John F P Bridges
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
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100
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Hutton DW, Rose A, Singer DC, Bridges CB, Kim D, Pike J, Prosser LA. Importance of reasons for stocking adult vaccines. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e334-e341. [PMID: 31747238 PMCID: PMC9004468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify the most important reasons underlying decisions to stock or not stock adult vaccines. STUDY DESIGN US physicians, nurses, pharmacists, and administrators of internal medicine, family medicine, obstetrics/gynecology, and multispecialty practices who were involved in vaccine stocking decisions (N = 125) completed a best-worst scaling survey online between February and April 2018. METHODS Sixteen potential factors influencing stocking decisions were developed based on key informant interviews and focus groups. Respondents selected factors that were most and least important in vaccine stocking decisions. Relative importance scores for the best-worst scaling factors were calculated. Survey respondents described which vaccines their practice stocks and reasons for not stocking specific vaccines. Subgroup analyses were performed based on the respondent's involvement in vaccine decision making, role in the organization, specialty, and affiliation status, as well as practice characteristics such as practice size, insurance mix, and patient age mix. RESULTS Relative importance scores for stocking vaccines were highest for "cost of purchasing vaccine stock," "expense of maintaining vaccine inventory," and "lack of adequate reimbursement for vaccine acquisition and administration." Most respondents (97%) stocked influenza vaccines, but stocking rates of other vaccines varied from 39% (meningococcal B) to 83% (tetanus-diphtheria-pertussis). Best-worst scaling results were consistent across respondent subgroups, although the range of vaccine types stocked differed by practice type. CONCLUSIONS Economic factors associated with the purchase and maintenance of vaccine inventory and inadequate reimbursement for vaccination services were the most important to decision makers when considering whether to stock or not stock vaccines for adults.
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Affiliation(s)
- David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Room M3525, Ann Arbor, MI 48109-2029.
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