基于离散选择实验的高血压与2型糖尿病共病患者家庭医生签约服务偏好属性及水平开发OA

Background Contracted family doctor service is the main way of community prevention and treatment of hypertension and type 2 diabetes.With the continuous development of the concept and practice of"patient-centered"medical and health services,accurate allocation of service attributes and levels based on patient preferences has become a key path to improve service accessibility,compliance and health outcomes.Objective This study takes the research on the preference choices of patients with comorbidity of hypertension and type 2 diabetes mellitus(HTN-T2DM)for family doctor contract services as an example,detailing the entire process of attribute and level development,providing a reference and guidance for the development of attributes and levels in discrete choice experiments(DCE),and offering a reference for formulating strategies for family doctor contract services for patients with HTN-T2DM.Methods Under the guidance of the consolidated framework for implementation research(CFIR),a literature review and policy analysis were conducted to extract and collate potential attributes and construct an attribute pool,semi-structured interviews were carried out with 5 family doctors,3 institutional principals,and 20 patients with HTN-T2DM from primary-health-care institution in Haikou city to specify the attributes and levels.Finally,50 HTN-T2DM patients were recruited by convenience sampling to participate in a pretest to verify the rationality of the attributes and levels.Results Through a literature review,23 literatures were combed,among which 15 were in Chinese and 8 in English,and 18 attributes were collated.In combination with semi-structured interviews,8 attributes and corresponding levels were determined.Through the pre-experiment,7 attributes and levels were ultimately determined,namely,the nature of the institution(government-run/social-run/individual-run),service content(health consultation and guidance/traditional Chinese medicine for preventive treatment of diseases/personalized examination items),service mode(institutional visit/remote diagnosis and treatment/home visit service),self-payment cost(50/100/200 yuan per month),doctor's professional title(junior/intermediate/senior),implementation environment(with priority referral/without priority referral),and medication guidance(2 weeks/1 month/2 months).Conclusion Scientifically determining attributes and their levels is a crucial foundation for ensuring the effectiveness of DCE.Under the guidance of the CFIR,this study develops 7 attributes and corresponding levels for the preference of family doctor contract services for patients with HTN-T2DM,providing a reference for advancing research on the preference of family doctor contract services for HTN-T2DM patients.Empirical research can be carried out based on these findings in the future to promote the improvement of family doctor contract service strategies.