Rachel Ibbotson

It’s All in the Name, or Is It? The Impact of Labeling on Health State Values:

Background. Many descriptions of health used in vignettes and condition-specific measures name the medical condition. This article assesses the impact of referring to the medical condition in the descriptions of health states valued by members of the general population. Methods. A valuation study was conducted using face-to-face interviews involving the time trade-off valuation technique. All respondents valued essentially the same health states, but for each respondent, the descriptions featured an irritable bowel syndrome (IBS) label, a cancer label, or no label. Random effects generalized least squares regressions were used to estimate the impact of each label and experience of the condition on health state values. Data. A sample of 241 members of the UK general population each valued 8 states, generating 1910 observations (response rate = 39%, completion rate = 99% for all states). Results. The authors find no significant difference between health state values when the description contains no label or an IBS label. They find that the inclusion of a cancer label in health state descriptions affects health state values and that the impact is dependent on the severity of the state, with a significant reduction in values for more severe health states (up to −0.25 for the worst possible state) but no significant difference for mild states. Conclusions. A condition label can affect health state values, but this is dependent on the specific condition and severity. The authors recommend avoiding condition labels in health state descriptions (where possible) to ensure that values are not affected by prior knowledge or preconception of the condition that may distort the health state being valued.

Valuing Health Using Time Trade-Off and Discrete Choice Experiment Methods: Does Dimension Order Impact on Health State Values?

BACKGROUND Health states defined by multiattribute instruments such as the EuroQol five-dimensional questionnaire with five response levels (EQ-5D-5L) can be valued using time trade-off (TTO) or discrete choice experiment (DCE) methods. A key feature of the tasks is the order in which the health state dimensions are presented. Respondents may use various heuristics to complete the tasks, and therefore the order of the dimensions may impact on the importance assigned to particular states. OBJECTIVE To assess the impact of different EQ-5D-5L dimension orders on health state values. METHODS Preferences for EQ-5D-5L health states were elicited from a broadly representative sample of members of the UK general public. Respondents valued EQ-5D-5L health states using TTO and DCE methods across one of three dimension orderings via face-to-face computer-assisted personal interviews. Differences in mean values and the size of the health dimension coefficients across the arms were compared using difference testing and regression analyses. RESULTS Descriptive analysis suggested some differences between the mean TTO health state values across the different dimension orderings, but these were not systematic. Regression analysis suggested that the magnitude of the dimension coefficients differs across the different dimension orderings (for both TTO and DCE), but there was no clear pattern. CONCLUSIONS There is some evidence that the order in which the dimensions are presented impacts on the coefficients, which may impact on the health state values provided. The order of dimensions is a key consideration in the design of health state valuation studies.

Views and experiences of using integrated care pathways (ICPs) for caring for people in the last days to hours of life: results from a cross-sectional survey of UK professionals

Objectives To determine the views and experiences of health and social care professionals on using integrated care pathways (ICPs)for caring for people in the last days to hours of life. Methods Online cross-sectional questionnaire survey of UK professionals working in UK primary and secondary care settings. Results 1331 professionals returned completed questionnaires. Ninety-three per cent (1138/1228) of respondents used the Liverpool Care Pathway (LCP) or local variant. Eighty-eight (1089/1234) felt ICPs enabled professionals to provide better care for individuals and their families/carers. ICPs were viewed as promoting patient-centred holistic care, improving pain and symptom control, providing guidance and standards and improving communication with patients/families. Sixty-two per cent (770/1234) had no concerns regarding the use of ICPs. Areas of concern included incorrect use and implementation of the ICP, poor communication with families, junior level staff making decisions and insufficient education and support. Conclusions There was strong support for using ICPs for caring for people in the last days to hours of life. ICPs were viewed as supporting high-quality patient-centred holistic care. Given the recommendations of the More Care Less Pathway report, those that develop the guidance and support that replace the LCP need to incorporate the aspects of this that have resulted in the benefits seen by professionals within this survey, but also learn from the instances where ICPs have failed to prevent poor care, or worse, have contributed to it.

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units

Objectives This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. Design Cohort study and survey data. Setting OOH appointments offered in four units in one region in England (October 2015 to November 2016). Methods Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. Results There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. Conclusions The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs.