A. Gilbert1,2, E. Mentzakis3, C. May4,5, M. Stokes2,6, H. Brown1, J. Jones2
1Royal National Orthopaedic Hospital, Therapies Department, Stanmore, United Kingdom, 2University of Southampton, School of Health Sciences, Southampton, United Kingdom, 3University of Southampton, Faculty of Economic, Social and Political Science, Southampton, United Kingdom, 4London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, United Kingdom, 5NIHR Applied Research Collaboration, North Thames, London, United Kingdom, 6NIHR Applied Research Collaboration, Wessex, United Kingdom

Background: Videoconferencing (VC) has been cited as being able to reduce the number of face-to-face (F2F) outpatient appointments over the next 10 years. VC has been shown to be acceptable, however, face to face care is still seen as the ‘gold standard’. The COVID-19 pandemic has highlighted the potential for VC to enable continuation of care.
The subject of this paper continues our previous research into patient preferences for VC in an orthopaedic rehabilitation setting. It is assumed that a patient will choose the option that they prefer (provides the most utility). A Discrete Choice Experiment (DCE) was designed to investigate the factors influencing preference for VC among patients attending orthopaedic rehabilitation. Qualitative interviews were conducted with a small sample of participants to support theorization into why the identified factors influence preference.

Purpose: To identify factors that influence patient preferences for video consultations in an orthopaedic rehabilitation setting. To explain why these factors influence preference.

Methods: Previous research from the CONNECT Project informed DCE development. The design of the DCE took into account best practice guidance (ISPOR good practice for conjoint analysis) during its development. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. To reduce the impact of cognitive fatigue the design was blocked into two ‘blocks’ of eight scenarios each. Three pilots were undertaken to refine the questionnaire, to ensure comprehension.  Quantitative analysis uses a binary logit regression models.  A small number of participants strongly in favour of F2F and VC were sampled for qualitative interview using content analysis to provide additional insight into the results.

Results: Two hundred and nineteen and 61 participants completed the ‘Block 1’ and ‘Block 2’ questionnaire, respectively. The study was terminated early due to COVID-19; as paired questionnaires from ‘Block 1’ and ‘Block 2’ were required for analysis, only 61 questionnaires (122 patients) were used. Duration of appointment, time of day, patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs significant predictors to preference, were significant predictors of preference. A simplified conceptual model has been developed to explain how these factors interact to inform preference; these include contextual, structural and relationship factors. Eight participants who strongly preferred F2F and five participants who strongly preferred VC were interviewed. These interviews provided underlying rationale for choices.

Conclusion(s): We successfully designed and conducted a discrete choice experiment that investigated the trade-offs between pathway factors for patients attending orthopaedic rehabilitation appointments. A conceptual model was designed to focus attention towards the factors that influences preferences.

Implications: An understanding of factors, such as those identified from this study, will enable clinicians to identify patients who prefer virtual consultations. The model developed from this study can inform the development of future technologies, trials and qualitative work to further explore the mechanisms that influence preference.

Funding, acknowledgements: Anthony Gilbert is funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship for this research (ICA-CDRF-2017-03-025).  

Keywords: Patient Preferences, Virtual Consultations, Orthopaedics

Topic: Service delivery/emerging roles

Did this work require ethics approval? Yes
Institution: Health Research Authority
Committee: London-Hampstead Research Ethics Committee
Ethics number: IRAS ID: 248064, REC Reference 19/LO/1586

All authors, affiliations and abstracts have been published as submitted.

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