Introduction
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction
Quality appraisal
Data analyses
Results
Study selection
Study and sample characteristics
Characteristics | Characteristics | ||||
---|---|---|---|---|---|
Study settings | n | % | Questionnaire design | n | % |
Publication year | Choice contextsa | ||||
2010–2022 | 21 | 60.0 | Choosing primary care for self (not specified) | 31 | 88.6 |
1997–2009 | 14 | 40.0 | Choosing primary care for self when the current one closes | 3 | 8.6 |
Choosing primary care for self after moving to a new city | 1 | 2.9 | |||
Continent | Choosing primary care for a friend / relative | 1 | 2.9 | ||
Europe | 23 | 65.7 | |||
Asia | 5 | 14.3 | Types of visitsa | ||
North America | 4 | 11.4 | Acute: minor | 19 | 54.3 |
Australia & New Zealand | 2 | 5.7 | Non-specific / otherc | 16 | 45.7 |
Africa | 1 | 2.9 | Chronic | 6 | 17.1 |
Acute: major | 4 | 11.4 | |||
Country’s income levelb | |||||
High income | 29 | 82.9 | Types of attributesa | ||
Low & middle income | 6 | 17.1 | Process | 33 | 94.3 |
Outcomes | 32 | 91.4 | |||
Sources of funding | Structure | 18 | 51.4 | ||
Government | 16 | 45.7 | |||
Not reported | 10 | 28.6 | Methods to identify attributes & levelsa | ||
Independent organization | 5 | 14.3 | Literature review | 25 | 71.4 |
Academic institution | 4 | 11.4 | Qualitative research | 22 | 62.9 |
Not reported | 4 | 11.4 | |||
Study samplesd | Mean | SE | Policy | 3 | 8.6 |
Sample size | 881.8 | 739.3 | Others | 3 | 8.6 |
Response rate (%) | 62.8 | 22.9 | Expert opinion | 2 | 5.7 |
Age | 51.6 | 8.7 | |||
Percentage of men (%) | 41.9 | 8.7 | Factors affecting preference heterogeneityae | ||
Did not examine any factor | 19 | 54.3 | |||
Type of conjoint analysis | n | % | Predisposing characteristics | 10 | 28.6 |
Choice-based | 33 | 94.3 | Enabling resources | 9 | 25.7 |
Rating-based | 2 | 5.7 | Needs | 5 | 14.3 |
Health behaviour | 2 | 5.7 | |||
Study design | n | % | |||
Recruitment setting | Methods to generate choice set | ||||
Primary care facilities | 19 | 54.3 | Software | 17 | 48.6 |
Community | 15 | 42.9 | Not reported | 16 | 45.7 |
Not reported | 1 | 2.9 | Catalogue | 2 | 5.7 |
Survey administration | Reported design efficiencyf | ||||
Self-completed | 22 | 62.9 | D-efficient | 19 | 54.3 |
Interviewer administered | 7 | 20.0 | Not reported | 16 | 45.7 |
Computerized interview | 3 | 8.6 | |||
Computer aided telephone | 2 | 5.7 | Study qualityg | n | % |
interview | Main analysis | ||||
Self-completed & Interviewer administered | 1 | 2.9 | High | 29 | 82.8 |
Low | 6 | 17.1 | |||
Study analyses | n | % | Sensitivity analysis | ||
Statistical modelsa | High | 25 | 71.4 | ||
Logit | 26 | 74.5 | Low | 10 | 28.6 |
Probit | 8 | 22.9 | |||
Latent class analyses | 3 | 8.6 | |||
Othersh | 2 | 5.7 |
Quality appraisal
Attributes of primary care
Evidence Level | Number of Attributes / Factors Affecting Preference Heterogeneity Overall or by Type of Visits | ||||
---|---|---|---|---|---|
Overall | Acute: Minor Conditions | Acute: Major Conditions | Chronic Conditions | Non-specific / Other Conditionsa | |
(a) Attributes of primary care | |||||
Main Analyses | |||||
Strong | 21 | 15 | 3 | 6 | 10 |
Moderate | 3 | - | - | - | 3 |
Limited | 34 | 21 | 12 | 14 | 22 |
Conflicting | - | - | - | - | - |
Inconclusive | - | 2 | 5 | - | 4 |
Total | 58 | 38 | 20 | 20 | 39 |
Sensitivity Analyses | |||||
Strong | 20 | 12 | 3 | 6 | 9 |
Moderate | 3 | 1 | - | - | 4 |
Limited | 29 | 20 | 12 | 14 | 19 |
Conflicting | - | - | - | - | - |
Inconclusive | 6 | 5 | 5 | - | 7 |
Total | 58 | 38 | 20 | 20 | 39 |
(b) Factors affecting preference heterogeneity | |||||
Main Analyses | |||||
Strong | 4 | 2 | - | - | 2 |
Moderate | - | - | - | - | - |
Limited | 31 | 23 | 4 | 7 | 7 |
Conflicting | 3 | 5 | - | - | 1 |
Inconclusive | 5 | 5 | - | - | - |
Total | 43 | 35 | 4 | 7 | 10 |
Sensitivity Analyses | |||||
Strong | 4 | 3 | - | - | - |
Moderate | - | - | - | - | - |
Limited | 28 | 23 | 4 | 7 | 7 |
Conflicting | 3 | 4 | - | - | - |
Inconclusive | 8 | 5 | - | - | 3 |
Total | 43 | 35 | 4 | 7 | 10 |
Strength of Evidence | Attributes according to levels of primary carea | ||
---|---|---|---|
Structure | Process | Outcome | |
Strong | 1.Ability to choose the providers they see (NA) | 1.Availability of convenient appointment time ( +) | 1.Amount of information received during consultation ( +) |
2.Experience of care provider ( +) | 2.Communication skills of healthcare provider ( +) | 2.Depth of explanation ( +) | |
3.Courtesy and respect for the patient ( +) | 3.Consideration of patient’s perspective ( +) | ||
4.Distance to practice – time (-) | 4.Involvement in decision making ( +) | ||
5.Drug availability ( +) | 5.Likelihood of having illness cured ( +) | ||
6.Length of consultation time ( +) | 6.Waiting time – appointment (-) | ||
7.Opening hours – extended ( +) | 7.Waiting time – clinic (-) | ||
8.Out-of-pocket cost (-) | |||
9.Quality of the physical exam ( +) | |||
10.See provider you know ( +) | |||
11.Treatment measures (NA) | |||
12.Type of consultation (NA) | |||
Moderate | None | 1.Distance to practice – miles/km (-) | 1.Waiting time – telephone (-) |
2.Opening hours – weekend ( +) | |||
Limited | 1.Amount of billing problems (0) | 1.Availability of home visits ( +) | 1.Attention to personal situation ( +) |
2.Facility size (0) | 2.Care for ongoing health conditions (chronic care) (0) | 2.Provider’s interpersonal manner ( +) | |
3.Management of clinic by government ( +) | 3.Familiarity with healthcare personnel ( +) | 3.Trustworthiness of the provider ( +) | |
4.Friendliness and helpfulness of staff ( +) | 4.Reassurance from the provider (+) | ||
5.General condition of medical equipment ( +) | 5.Support for emotional distress ( +) | ||
6.Insurance reimbursement ( +) | 6.Provider notices what you say about your health (legitimation) ( +) | ||
7.Limited provision of acute care (0) | 7.Entire time spent to seek and obtain treatment (0) | ||
8.Availability of modern diagnostic equipment ( +) | 8.Patient satisfaction ( +) | ||
9.Multidisciplinary care ( +) | 9.Waiting time – general (-) | ||
10.Opening hours – lunchtime ( +) | 10.Waiting time – referral (-) | ||
11.Opening hours – number of days ( +) | 11.Whether practice meets your specific health needs ( +) | ||
12.Personal connection in the facility (0) | |||
13.Provider’s knowledge of the patient ( +) | |||
14.Practice knows your local services (-) | |||
15.Primary care work model ( +) | |||
16.Prior expert treatment ( +) | |||
17.Provision of preventive care (0) | |||
18.See person who has information about your medical history ( +) | |||
19.Voluntary contribution (in addition to out-of-pocket cost) (-) | |||
20.Availability of technical equipment ( +) |
Factors affecting preference heterogeneity of primary care
Strength of Evidence | Factors affecting preference heterogeneity, according to Andersen’s framework | |||
---|---|---|---|---|
Enabling | Health Behaviors | Need | Predisposing | |
Strong | 1.Employment status | None | None | 1.Age |
2.Income level | 2.Gender | |||
Limited | 1.Activity if not visiting doctor: Attending college | 1.Facility visiting experience: Higher levels | 1.Appointment for a child | 1.Marital status |
2.Activity if not visiting doctor: Cleaning house | 2.Appointment for another person | 2.Number of family members | ||
3.Activity if not visiting doctor: Looking after children | 3.Frequency of GP Visits in the last year: < 3 times | 3.Region | ||
4.Activity if not visiting doctor: Other activity | 4.Reason for appointment: Emergency | 4.You trust in your GP: Yes | ||
5.Activity if not visiting doctor: Work | 5.Reason for appointment: Long standing physical problem | |||
6.Advice was given by GP in current visit: Yes | 6.Reason for appointment: New problem | |||
7.Car ownership: Yes | 7.Reason for appointment: Psychological problem | |||
8.Carer status: Yes | 8.Severity of symptoms | |||
9.Current GP works with another GP | ||||
10.Ever had second opinion | ||||
11.GP involved you in the decision: Yes | ||||
12.GP listened to you carefully: Yes | ||||
13.Insurance type: High premium | ||||
14.Living alone: Yes | ||||
15.Prior experience putting off seeking care from GP: Yes | ||||
Inconclusive | 1.Current waiting time at present appointment | 1.Time since last visit | 1.Technical equipment available | None |
2.Distance to health care centre | 2.Reason to see GP in current visit: general / minor illness | |||
3.Present registration with GP | ||||
4.Decision making at last visit | ||||
5.GP provided a lot of information at last visit | ||||
Conflicting | None | None | 1.Chronic disease status: Yes | 1.Education level |
2.Health Status: Poor |