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Abstract
Objectives To measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries.
Design A discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity.
Setting Preference data collected in Austria (AT), Croatia (HR), Germany (DE), Hungary (HU), the Netherlands (NL), Norway (NO), Spain (ES), and UK.
Participants Patients with multimorbidity, partners and other informal caregivers, professionals, payers and policymakers.
Main outcome measures Preferences of participants regarding outcomes of integrated care described as health/well-being, experience with care and cost outcomes, that is, physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and total costs. Each outcome had three levels of performance.
Results 5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological well-being and continuity of care. Continuity of care also entered the top-three of professionals, payers and policymakers in four countries (AT, DE, HR and HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL and NO and higher weights to person-centredness in AT, DE, ES and HU. Payers and policymakers assigned higher weights than patients to costs, but these weights were relatively low.
Conclusion The well-being outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision-making, whereby efforts to improve well-being and person-centredness should not divert attention from improving physical functioning.
- primary care
- health economics
- international health services
- organisation of health services
- public health
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Footnotes
Contributors MRvM was the coordinator of SELFIE, designed the study, had access to the data from all countries, supervised the analyses, controlled the decision to publish and wrote the paper. She accepts full responsibility for the conduct of the study. MK was part of the coordinating team of SELFIE, contributed to data analysis, interpretation of data for all countries and writing the paper. FL was part of the coordinating team of SELFIE, co-designed the study, contributed to data collection, data analyses, interpretation of data for all countries and reviewed the paper. MH was part of the coordinating team of SELFIE, co-designed the study, contributed to data collection, data analyses, interpretation of data for all countries and reviewed the paper. WL was part of the coordinating team of SELFIE, co-designed the study, contributed to data collection, data analyses, interpretation of data for all countries and reviewed the paper. KI contributed to the translation of the DE into Norwegian, data collection and interpretation in Norway and reviewed the paper. JEA contributed to the translation of the DE for Norway, data collection and interpretation in Norway and reviewed the paper. MK contributed to the translation of the DE for Austria, data collection and interpretation in Austria and reviewed the paper. VS contributed to the translation of the DE for Germany, data collection and interpretation in Germany and reviewed the paper. DR contributed to the translation of the DE for Croatia, data collection and interpretation in Croatia and reviewed the paper. JP contributed to the translation of the DE for Hungary, data collection and interpretation in Hungary and reviewed the paper. IC contributed to the translation of the DE for Spain, data collection and interpretation in Spain and reviewed the paper. JS contributed to the translation of the DE for the UK, data collection and interpretation in the UK and reviewed the paper. MJ optimised the DE designs, conducted the Bayesian statistical analyses and reviewed the paper.
Funding The SELFIE project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634288.
Disclaimer The content of this paper reflects only the SELFIE group’s views and the European Commission is not liable for any use that may be made of the information contained herein.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. The individual-level DCE data will not be made publicly available. Upon request to the corresponding author, we may consider in collaboration with the respective SELFIE-partner, whether country-specific data can be shared. Other findings from the overarching SELFIE study can be found on the SELFIE website https://www.selfie2020.eu/.