Outcome preferences of older people with multiple chronic conditions and hypertension: a cross-sectional survey using best-worst scaling.

Autor: Aschmann HE; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Puhan MA; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Robbins CW; Center for Clinical Information Services, Kaiser Permanente Care Management Institute, Oakland, CA, USA.; Kaiser Permanente National Guideline Program, Oakland, CA, USA.; Guidelines International Network, Board of Trustees, Denver, CO, USA.; Family Medicine, Colorado Permanente Medical Group, Denver, CO, USA.; Clinical Education MOC Portfolio, The Permanente Federation, Oakland, CA, USA., Bayliss EA; Institute for Health Research, Kaiser Permanente, Denver, CO, USA.; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA., Chan WV; Kaiser Permanente Northwest, National Guideline Program, Portland, OR, USA., Mularski RA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.; Department of Pulmonary & Critical Care Medicine, Northwest Permanente, Portland, OR, USA.; Oregon Health & Science University, Portland, OR, USA., Wilson RF; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA., Bennett WL; Division of General Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA., Sheehan OC; Division of Geriatrics and Gerontology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA., Yu T; Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan., Yebyo HG; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Leff B; Division of Geriatrics and Gerontology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA., Tabano H; Institute for Health Research, Kaiser Permanente, Denver, CO, USA., Armacost K; Division of Geriatrics and Gerontology, Patient and Caregiver Partner Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Glover C; Division of Geriatrics and Gerontology, Patient and Caregiver Partner Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Maslow K; Division of Geriatrics and Gerontology, Patient and Caregiver Partner Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Gerontological Society of America, Washington, District of Columbia, USA., Mintz S; Division of Geriatrics and Gerontology, Patient and Caregiver Partner Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Family Caregiver Advocacy, Kensington, MD, USA., Boyd CM; Division of Geriatrics and Gerontology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA. cyboyd@jhmi.edu.
Jazyk: angličtina
Zdroj: Health and quality of life outcomes [Health Qual Life Outcomes] 2019 Dec 19; Vol. 17 (1), pp. 186. Date of Electronic Publication: 2019 Dec 19.
DOI: 10.1186/s12955-019-1250-6
Abstrakt: Background: Older people with hypertension and multiple chronic conditions (MCC) receive complex treatments and face challenging trade-offs. Patients' preferences for different health outcomes can impact multiple treatment decisions. Since evidence about outcome preferences is especially scarce among people with MCC our aim was to elicit preferences of people with MCC for outcomes related to hypertension, and to determine how these outcomes should be weighed when benefits and harms are assessed for patient-centered clinical practice guidelines and health economic assessments.
Methods: We sent a best-worst scaling preference survey to a random sample identified from a primary care network of Kaiser Permanente (Colorado, USA). The sample included individuals age 60 or greater with hypertension and at least two other chronic conditions. We assessed average ranking of patient-important outcomes using conditional logit regression (stroke, heart attack, heart failure, dialysis, cognitive impairment, chronic kidney disease, acute kidney injury, fainting, injurious falls, low blood pressure with dizziness, treatment burden) and studied variation across individuals.
Results: Of 450 invited participants, 217 (48%) completed the survey, and we excluded 10 respondents who had more than two missing choices, resulting in a final sample of 207 respondents. Participants ranked stroke as the most worrisome outcome and treatment burden as the least worrisome outcome (conditional logit parameters: 3.19 (standard error 0.09) for stroke, 0 for treatment burden). None of the outcomes were always chosen as the most or least worrisome by more than 25% of respondents, indicating that all outcomes were somewhat worrisome to respondents. Predefined subgroup analyses according to age, self-reported life-expectancy, degree of comorbidity, number of medications and antihypertensive treatment did not reveal meaningful differences.
Conclusions: Although some outcomes were more worrisome to patients than others, our results indicate that none of the outcomes should be disregarded for clinical practice guidelines and health economic assessments.
Databáze: MEDLINE
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