Patients’ preferences for the management of knee injuries: a discrete choice experiment
Abstract
Objectives
To elicit the preferences in two cohorts of patients with knee injuries who had been referred by their General Practitioner (GP) for Magnetic Resonance Imaging (MRI) or orthopaedic consultation; or were listed for an arthroscopy.
Methods
A discrete choice experiment using a postal questionnaire asked for patients’ preferences for, and trade-offs between, the attributes of waiting time for diagnosis, treatment time, change in knee problem and out of pocket expenses.
Results
Participants with knee injuries who responded to the questionnaire were: 148 of 218 (68%) in the GP cohort; and 95 of 121 (79%) in the arthroscopy cohort. Waiting time for diagnosis and treatment, as well as change in knee problem, were statistically significant important attributes. This applies less to out-of-pocket expenses although patients in the arthroscopy cohort were significantly more willing to pay extra for their treatment. There were no significant interactions between employment status and cost. For patient-related quality of
life, attributes for choosing a shorter time to diagnosis or treatment were statistically significant or borderline.
Conclusion
Patients with knee injuries find shorter waiting time for diagnosis and treatment to be important as well as improvements in their knee problem. Out-of-pocket expenses were less important, except for patients waiting for an arthroscopy who were willing to pay extra.
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Department of Health. (2000) The NHS Plan: a plan for investment, a plan for reform.
London: The Stationary Office.
Department of Health. (2004) The NHS Improvement Plan: Putting people at the heart of public services. London: The Stationary Office.
Barrett, A. (2005) Waiting times for scans to decrease, vows Department of Health.
British Medical Journal, 331, 256.
Office of Population Censuses and Surveys. (1995) Morbidity statistics from general practice: fourth national study 1991-92. London: Stationary Office.
Mackenzie, R., Dixon, A.K., Keene, G.S., Hollingworth, W., Lomas, D.J., Villar, R.N. (1996) MRI of the knee: assessment of effectiveness. Clinical Radiology, 51, 245-250.
Southgate, J., Thomas, N. (1995) MRI should be used selectively (letter). British Medical
Journal, 312, 849.
Mackenzie, R., Edwards, D., Dixon, A.K. (1996) Patients should be seen by an experienced orthopaedic clinician (letter). British Medical Journal, 312, 849–850.
Brealey, S.D., Atwell, C., Bryan, S. et al. (2006) The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee. BMC Health Services Research,
, 133.
DAMASK Trial Team. (2008) Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised controlled trial. British Journal of General Practice, 58, 767-774.
DAMASK Trial Team. (2008) Cost-effectiveness of magnetic resonance imaging of the knee for patients presenting in primary care. British Journal of General Practice, 58, 775-
Brealey, S., Andronis, L., Dale, V., Gibbon, A., Gilbert, F., Hendry, M., Hood, K., King, D., Wilkinson, C. on behalf of the DAMASK Trial Team. (2012) The effect of waiting times from General Practitioner referral to Magnetic Resonance Imaging or orthopaedic consultation for the knee on patient-based outcomes. British Journal of Radiology,
(1019), e1134.
Sculpher, M., Bryan, S., Fry, P., de Winter, P., Payne, H., Emberton, M. (2004)
Patients’ preferences for the management of non-metastatic prostate cancer: discrete choice experiment. British Medical Journal, 328, 382–384.
Gerard, K., Salisbury, C., Street, D., Pope, C., Baxter, H. (2008) Is fast access to
general practice all that should matter? A discrete choice experiment of patients’ preferences. Journal of Health Services Research & Policy, 13, 3-10.
Scott, A., Wastson, M.S., Ross, S. (2003) Eliciting preference of the community for out- of-hours care provided by general practitioners: a stated preference discrete choice experiment. Social Science & Medicine, 50, 803-814.
Bryan, S., Buxton, M., Sheldon, R., Grant, A. (1998) Magnetic resonance imaging for the investigation of knee injuries: an investigation of preferences. Health Economics, 7,
-603.
Garratt, A., Brealey, S., Robling, M., Attwell, C., Russell, I., Gillespie, W., King, D on behalf of the DAMASK Study Team. (2008) Development of the Knee Quality of Life (KQoL-26) 26-item questionnaire: data quality, reliability, validity and responsiveness. Health and Quality of Life Outcomes, 6, 48.
Ware, J.E., Kosinski, M., Dewey, J.E. (2000) How to score Version 2 of the SF-36
Health Survey. Lincoln: QualityMetric Incorporated.
Brooks, R. (1996) EuroQol: the current state of play. Health Policy, 37, 53-72.
Ryan, M., Major, K., Skatun, D. (2004) Using discrete choice experiments to go beyond clinical outcomes when evaluating clinical practice. Journal of Evaluation in Clinical Practice, 11, 328-338.
Williams, J.I., Llewellyn Thomas, H., Arshinoff, R., Young, N., Naylor, C.D. (1997) The burden of waiting for hip and knee replacement in Ontario. Journal of Evaluation in Clinical Practice, 3, 59-68.
Kelly, K.D., Voaklander, D.C., Johnston, D.W.C., Newman, S.C., Suarez-Almazor, M.E. (2001) Change in pain and function while waiting for major joint arthroplasty. The Journal of Arthrosplasty, 16, 351-359.
Hirvonen, J., Blom, M., Tuominen, U., Seitsalo, S., Lehto, M., Paavolainen, P., Hietanieme, K., Rissanen, P., Sintonen H. (2007) Evaluating waiting time effect on health outcomes at admission: a prospective randomised study on patients with osteoarthritis of the knee joint. Journal of Evaluation in Clinical Practice, 13, 728-733.
Robling, M.R., Pill, R.M., Butler, C.C. (2009) Time to talk? Patient experiences of waiting for clinical management of knee injuries. Quality & Safety in Health Care, 18,
-146.
DOI: http://dx.doi.org/10.5750/ejpch.v2i4.822
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