Patient Preferences for Using Remote Care Technology in Heart Failure: Discrete Choice Experiment

Background:

Remote care technology has been used to bridge the gap between healthcare in a clinical setting and in the community, all the more essential post-covid. Patients with chronic conditions may benefit from interventions that could provide more continuous and frequent monitoring of their disease process and support self-management. A common barrier however is the lack of engagement with technological interventions or devices that provide care remotely, which could lead to loss of resources invested and reduced quality of care.

Objective:

This discrete choice experiment elicits the preferences of heart failure patients with regard to potential remote care technologies that they would be willing to engage with, and in turn creates a hierarchy of factors that can affect engagement, for use within future technology design.

Methods:

A survey was created using discrete choice design and with input from a PPI group. It was distributed to patients with heart failure online via social media and patient support groups. The attributes used for the experiment were based on a previous systematic review looking at factors that affect engagement in remote care, and which generated five central themes, each of which was assigned to an attribute directly: communication (increasing interaction between patients and healthcare staff/carers/other patients), clinical care (improving the quality of care compared to established practice), education (providing tailored information to help with self-care and reduce uncertainty), ease of use (the technical aspects of the intervention are easy to handle without issues) and convenience (the intervention fits well around the patient’s lifestyle and requires minimal effort). Each of the five themes had two levels, positive and negative. The survey presented participants with multiple forced-choice two alternative scenarios of remote care which allowed them to trade attributes according to their preference. The results were analysed using binary logit to obtain preference weights for each attribute.

Results:

A total of 93 completed responses were entered into the analysis. The results of the binary logit created coefficients for each attribute which equated to the relative preference of the associated themes: clinical care = 2.022, education = 1.252, convenience = 1.245, ease of use = 1.155, communication = 1.040. All calculated coefficients were statistically significant (p<0.01).

Conclusions:

The results show that the most preferred factor, clinical care, has enough value to be traded for approximately any two other factors. It also shows that the factor of communication is the least preferred attribute. Technology designers can use the associated preference weights to determine the relative increase of value perceived by patients by adding in certain attributes, with the greatest gains achieved by prioritising clinical care. This would result in increased engagement in a chronic heart failure population that would benefit most from remote care