Terry Porteous, Christine Bond,

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Managing minor illness Factors influencing the
choice between self-care and health professional
advice a discrete choice experiment.

• Terry Porteous, Christine Bond,
• Phil Hannaford, Mandy Ryan,
• Sally Wyke
• Enhancing self-care
• Dundee 2006

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Background

• Government in Scotland has expressed support
  for
• pharmacy-based advice and management of minor
• illnesses
• We are in the initial stages of negotiating a
  new contract for community pharmacists. The focus
  will be on the contribution pharmacists make to
  health improvement, chronic disease management
  and community pharmacy-led treatment of minor
  illness.
• PARTNERSHIP FOR CARE, SCOTLAND'S HEALTH
  WHITE PAPER February 2003

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Background

• Minor ailments service has been piloted and
  rolled out in two regions
• Transfer of minor ailments consultations from GP
  to pharmacy has been limited
• Previous survey of medicines use

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Medicines study 2002 - summary

• Response rate of 56.2 (electoral roll sample,
  n1501)
• 52 of all respondents had used at least one
  non-prescription medicine in the previous two
  weeks.
• 37 of all respondents had used a
  non-prescription analgesic in the previous two
  weeks.

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A focused approach

• Decision-making may depend on symptoms and OTC
  medicines available to treat
• Previous survey confirmed that analgesics were
  widely used
• Focus was on symptoms normally associated with
  analgesic use

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Study design

• Qualitative interviewsAim - To describe what
  factors influence patients when deciding how to
  manage minor ailments associated with analgesic
  use
• Discrete choice experimentAim - To describe what
  trade-offs people make when deciding how to
  manage minor ailments associated with analgesic
  use

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Qualitative interviews

• 24 interviews across Scotland asking about
• recent experience and management of symptoms
  associated with analgesic use.
• reasons for practising self-care and/or
  consulting health professionals
• opinions on self-care and use of analgesics

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Influencing factors Reasons for practising
self-care

• Faster treatment/easier access
• Use of complementary treatments
• Avoidance of unwanted treatments
• Feelings of control/independence
• Previous experience of same symptoms
• Advice from friends, relatives or media
• Perception that condition is self-inflicted
• Belief that GP will be of limited help
• Does not want to waste Drs time

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Influencing factors Reasons for not practising
self-care

• Having to pay for treatments yourself
• No advice from Dr/pharmacist
• Chance of missing important condition
• Chance of drug interactions
• Chance of making things worse
• Belief that nothing can help or stoicism
• Lack of knowledge
• Belief that only medical help will work

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Discrete choice experiment

• Used to elicit preferences in health care
• Shows the relative importance of influencing
  factors
• Allows us to measure trade-offs
• Willingness-to-pay

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The best of everything?
Ticket price
Check-in service
Entertainment
Food and drink
Legroom
Reclining chair
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The attributes

• The influencing factors
• Type of management (self-care, GP, pharmacy,
  practice nurse, complementary, NHS24, do nothing)
• Time to treatment (the time you have to wait for
  an appointment, travel time and time taken to get
  any treatment )
• Cost (travel costs and the cost of any treatment
  e.g. any consultation fee, over-the-counter
  medicines, complementary remedies etc).

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The scenario

• Please imagine this situation  
• You have a headache and a fever, your bones
  are aching and your nose feels slightly blocked
  up. You are still able to do all the things you
  usually do but are more tired than usual. The
  symptoms started to appear four days ago, and
  were slightly worse when you woke up this
  morning.

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A sample question
Example Which option would you choose?

(Tick ONE box only)
Option 1
Option 2 Do nothing
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DCE analysis and results

• DCE administered during November 2005
• Response rate of 57 (326/573)
• Analysed using multinomial logistic regression in
  STATA
• Regression coefficients used to estimate -
  utility (preferences or satisfaction) -
  willingness-to-pay

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Preferences

• For the symptoms presented
• Respondents had a general preference for doing
  something (rather than do nothing)
• Relative preferences for type of management
  Self-care Community
  pharmacy GP consultation
  Practice nurse NHS24
  Complementary

Decreasing preference
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Willingness-to-pay

• Respondents valued self-care at 22.67 i.e they
  were prepared to pay up to 22.67 to treat these
  symptoms by self-care but beyond this price, they
  would rather do nothing.
• They valued other treatment options less highly
  e.g. they would pay 17.05 LESS than this to
  treat symptoms using the NHS24 option
• They were prepared to pay 3.71 to reduce the
  wait to treat symptoms by 1 day

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Moving from one service to another

• Moving from NHS24 to pharmacy management
  gives an increase in utility
• Moving from a wait of 5 hours to 1 day gives
  a decrease in utility
• Overall difference in utility is positive
  and we can quantify it by WTP
• Rather than get telephone advice from NHS24
  with a 5 hour wait, a respondent would be
  willing to pay an extra 10.62 to get advice
  from a pharmacy with a wait of 1 day

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Conclusions

• Self-care was the preferred way of dealing with
  these symptoms
• It was highly valued by respondents
• Community pharmacy was the preferred source of
  professional advice
• Findings could be used to inform development of
  new models of service to support self-care
• Further analysis planned to look for differences
  in sub-groups

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Acknowledgements

• This work was funded by the Chief Scientist
• Office of the Scottish Executive as part of a
• Research Training Fellowship