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Health services and policy poster session 6: services
P5-S6.32 Using a contingent valuation method to understand consumer preferences for care of adolescents with pelvic inflammatory disease (PID)
  1. M Trent1,
  2. Q Qian2,
  3. K Frick3,
  4. C Thompson3,
  5. A Butz4,
  6. J Ellen4,
  7. H Lehmann4
  1. 1Johns Hopkins University School of Medicine, Baltimore, USA
  2. 2University of Maryland, Towson, USA
  3. 3Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
  4. 4Johns Hopkins School of Medicine, Baltimore, USA

Abstract

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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