What are patient preferences for virtual consultations for orthopaedic rehabilitation? Results from a discrete choice experiment (DCE) and qualitative interviews

ABSTRACT

Keywords Patient preferences, Virtual consultations, Musculoskeletal Purpose: 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. 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 (as iy 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 theorisation into why the identified factors were important. The purpose of this research was 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 have 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. Impact 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 Health Education England (HEE) and National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship for this research project (ICA-CDRF-2017-03-025).