Objective Adolescent girls diagnosed with PID are at higher risk for subsequent sexually transmitted infection (STI), pregnancy, and long-term pelvic pain. Although the 72-h post-PID evaluation provides an opportunity for risk reduction counselling, few adolescents adhere. Use of public health nurses (PHN) for clinical follow-up may meet the needs of this vulnerable population. The objective of this study is to estimate consumers' willingness-to-pay (WTP) for follow-up PID services by physicians and PHNs, differences by consumer type, and the differences in health-provider predicted consumer WTP values and actual consumer WTP values.
Methods A contingent valuation method was used to collect WTP data regarding co-payments to physicians or nurses for clinical service delivery from the consumers of adolescent PID services (parents (n=121) and adolescents (n=134)) and a national sample of health providers (n=102). Consumers were recruited from an academic paediatric practice and school-based health clinics in a large urban community with high STI prevalence. Participants completed a web-based survey with data uploaded to a secure server after obtaining online consent. Data were analysed using linear regression analyses.
Results The mean WTP for physician services was $16 (SD $16.9) for clinicians, $81.9 ($34.0) for parents, and $72 (SD $ 39.1) for adolescents. The mean WTP for PHN services was $13.6 (SD $17.4) for physicians, $62.4 (SD $44.1) for parents, and $49.7 (SD $44) for adolescents. Using physician estimates for WTP as the reference group, adolescents were willing to pay $56 more (95% CI 48.6 to 63.4) for physician care and parents were willing to pay $66 more (95% CI 59.0 to 72.8) than physician's predicted controlling for informant employment status. Adolescents were willing to pay $36 more (95% CI 48.6 to 63.4) for community-based nursing care and parents were willing to pay $48 more (95% CI 59.0 to 72.8) than physician's predicted. Consumers' (adolescents' & parents') WTP for physician services were on average $18.50 higher than PHN services (p=0.01).
Conclusion While adolescents and parents prefer physician follow-up for PID based on WTP, they are amenable to PHN follow-up visits. Our data suggest that health providers underestimate the value the consumers place on clinical service for PID. Given poor adherence to office-based follow-up and consumer interest in PHN visits, additional research evaluating the effectiveness of PHN visits for PID is warranted.
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