Study On Community Health Service Preference Of Chronic Disease Patients Based On The Best-worst Scaling Method

Objective:A community-based approach to address chronic diseases has been acknowledged and recognized as one of the most cost-effective solutions.The purpose of this study is to explore the demand and preference for personalized community health services of patients with chronic diseases under the background of community policies and measures for the prevention and treatment of chronic diseases.Methods:In this study,we sampled chronic disease patients in 11 cities of Shanxi Province with the help of the random number table and adopted the multi-stage random sampling method.968 questionnaires were actually collected,among which 861 were valid,and the effective questionnaire recovery was 86.1%.The Stata/SE 15.1 software was used for descriptive statistics and model building.The Conditional Logit Model was used to estimate the utility weight of each attribute level.The Mixed Logit Model was used to compare the importance of each attribute,incorporating the interaction between preference heterogeneity and attribute level.Results:The samples of male and female chronic disease patients were balanced,including444(51.57%)female chronic disease patients;452 chronic disease patients were aged 65 years or older(52.5%);The vast majority of chronic disease patients were not live alone(72.47%);The average education level of chronic disease patients was 10.35±5.031 years.534 chronic disease patients were registered in urban areas(62.02%);There were 470 chronic disease patients(54.59%)whose per capita family income was 3,000 yuan or above;A total of 291 patients(33.80%)had multiple chronic diseases.From high to low,the utilization rate of chronic disease patients to community health services was: “medication reminder service”(35.54%),“drug review and management service”(34.96%),“integrated traditional Chinese and Western medicine service”(29.51%),“emergency rescue service”(28.69%),“continuous drug delivery service based on continuous prescription service”(28.46%),“rehabilitation training and guidance service”(25.67%),“psychological counseling service”(24.74%),“house call service”(24.62%),“hospital bed at home service”(21.84%),and “remote visit service”(21.02%).The results of Conditional Logit Model showed that “continuous drug delivery service provided by online platform”,“medication reminder service”,“remote visit service”,and“integrated traditional Chinese and Western medicine service” were the reference levels of drug supply/continuous prescription,rational drug use,disease diagnosis and treatment,and rehabilitation nursing,respectively.Mixed Logit Model results showed that the significant utility of chronic patients’ preference for “continuous drug delivery services provided by community pharmacies”was 1.75(95%CI,1.54-1.96).The significant utility of preference for “continuous drug delivery service provided by online platform” was 1.14(95%CI,0.87～1.40)and that of preference for “emergency rescue service” was 0.76(95%CI,0.63～0.90).The significant utility of preference for “house call service” was 0.48(95%CI,0.34-0.62);The significant utility of preference for “hospital bed service” was-0.42(95%CI,-0.57～-0.53);The significant effect of preference for “drug review and management service” was-0.83(95%CI,-1.00～-0.67);The significant effect of preference for “medication reminder service” was-0.90(95%CI,-1.71～-0.72);The significant effect of preference for“psychological counseling service” was-0.92(95%CI,-1.07～-0.76);There was no significant effect on the preference of “remote visit service” and “rehabilitation training and guidance service”.The relative importance of each attribute in descending order was rehabilitation nursing,disease diagnosis and treatment,drug supply/continuous prescription,rational drug use.In terms of the four attributes of drug supply/continuous prescription,rational drug use,disease diagnosis and treatment,and rehabilitation nursing,the preference weight of patients with chronic diseases to “continuous drug delivery services provided by community pharmacies”,“drug review and management service”,“emergency rescue service” and “integrated Chinese and Western medicine service” was higher than other attributes levels.The results of the Mixed Logit Model after adding the interaction terms at the level of demographic characteristics and attributes showed that the coefficients of the two interaction terms “continuous drug delivery service provided by community pharmacies ×whether to live together” and “continuous drug delivery service provided by community pharmacies × multimorbidity situation” were significant and positive.The interaction coefficients of “drug review and management service × multimorbidity situation” and“medication reminder service × multimorbidity situation” were significant and negative.Conclusions:The most commonly used community health service for patients with chronic diseases is medication reminder service,while the least used community health service is remote visit service.Patients with chronic diseases preferred “continuous drug delivery service provided by community pharmacies”,“continuous drug delivery service provided by online platform”,“emergency rescue service” and “home visit service”,but were not so sensitive to “hospital bed service”,“drug review and management service”,“medication reminder service” and “psychological counseling service”.Patients with chronic diseases pay more attention to rehabilitation nursing,disease diagnosis and treatment,drug supply/continuous prescription,but pay less attention to rational drug use.People with chronic diseases who do not live alone and who have multimorbidity are more likely to choose “continuous drug delivery services provided by community pharmacies”;Patients with a single chronic disease were more likely to choose “drug review and management service” and “medication reminder service”.