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DISCRETE CHOICE EXPERIMENTS' TO VALUE INCREASED ROLES FOR THE PHARMACIST
IN THE MANAGEMENT OF DRUG THERAPY
Tinelli, M., Ryan, M., Bond, C.
Department of General Practice and Primary Care, University of Aberdeen,
Westburn Road, Aberdeen, AB25 2AY. Email: m.tinelli@abdn.ac.uk
Introduction
An extended role for pharmacists in medicine management, clinical
decision-making and patient support is being increasingly recognised.
Policy documents encourage appropriate use of pharmacists' skills and
expertise in delivering services and have already introduced enhanced
programmes of care. Supplementary prescribing by community pharmacists
is the most ambitious of recent initiatives .
The aim of this study was to investigate patients' preferences for an
innovative prescribing role for pharmacists in the management of drug
therapies, compared to the more traditional role. The perceived benefits
are an increased convenience for the patient and more efficient use of
the healthcare workforce.
Methods
The project was a cross-sectional pilot study based in two city centre
multi partnered General Practice in Aberdeen, Scotland. A self-completed
questionnaire was administered to a convenience sample of patients aged
> 18 years waiting to see their doctor at the surgery. A Discrete Choice
Experiment (DCE) was used to elicit patient preferences for extending
the role of the pharmacist to include prescribing as well as dispensing.
The new service proposed was compared to both the current situation and
alternative dispensing pharmacist scenarios. Attributes included were:
time spent travelling to, and waiting in, the GP surgery; time spent travelling
to, and waiting in, the pharmacy; chance of receiving the "best"
treatment; and cost. A multinomial regression analysis was used to estimate
factors that influence patients' preferences, their relative importance,
trade-offs between attributes and willingness to pay for alternative ways
of managing drug treatment.
Results
244 people were approached and 204 returned an evaluable questionnaire.
All attributes, except time spent travelling to, and waiting in, the pharmacy,
were important in choosing the service. A unit change in the 'best' treatment
and 'cost' attributes was the most important. The respondents were willing
to pay over £10 for a 1% improvement in the 'best' treatment attribute
and £1 for a 20-minute reduction in time spent travelling and waiting
to see the doctor. Everything else being equal, respondents preferred
the current situation to either a pharmacist prescribing and dispensing
role, or alternative dispensing only services. However, they could be
compensated for changes from the current situation by improvements in
the best treatment and GP time attribute. When older individuals providing
constant preferences for the whole choice set were dropped, respondents
preferred the innovative service to any other dispensing only option and
they were prepared to pay £7 to move to the new service.
Discussion
Overall, patients value input from their pharmacists, but are resistant
to change, with evidence of preferences for the current situation. Younger
people, who are willing to trade between alternatives, preferred the innovative
prescribing and dispensing service. The role of pharmacists in medicine
management and clinical decision-making is clearly an important policy
concern. UK has already supported a greater NHS role for pharmacist prescribing
and supply of both OTC and prescription medicine. Results from the present
study show that further changes could be supported by the public. The
DCE approach has been shown to be useful in valuing preferences for pharmacy
services.
Presented at the HSRPP Conference 2006, Bath
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