Designing a service framework for electronic personal health records for diabetes self management

Abstract

With the increase in the prevalence of diabetes and the resultant greater demand for diabetes services, and with fewer resources to pay for them, diabetes has become a multi-billion dollar economic burden the world over. Electronic personal health records (ePHRs) have been positioned as transformational agents that facilitate productive interactions between patients and their healthcare providers, and support self-management of chronic diseases such as diabetes. In keeping with a patient-centred model of care, healthcare services such as ePHRs that incorporate patients’ preferences and level of activation are being sought to increase and sustain patients’ utility of these services. This study examines patients’ preferences for the attributes of an ePHR service that supports diabetes self-management. It also explores factors that might influence their preferences. Conjoint analysis, one of the most widely used approaches to predict consumer preferences was chosen for this study. Specifically, adaptive choice-based conjoint analysis was used to identify the attributes of a winning ePHR service framework. Using Sawtooth Software’s suite of interviewing products, a web-based survey was developed comprising six ePHR service attributes. Hierarchical Bayes estimations were used to quantify patient preferences while latent class analysis was used to segment the sample. Additional statistical analyses were conducted to identify any significant relationships between patient characteristics and their preferences. A stratified sample of 150 patients with Type 1 diabetes, Type 2 diabetes, and Prediabetes were unwavering in their preference for an internet-based ePHR service supplied by a physician or specialist. They also preferred to exchange their health information with their physician or nurse, once a month, at no cost. Monthly service fees were considered the most important ePHR service attribute. These results were applied in market simulations and sensitivity analyses to uncover the more complex effects of the ePHR attributes on the overall utility of the service. Exchanging health information every two to three months as opposed to once a month, and offering an ePHR service in the form of a monitoring device as opposed to an internet-based application, may be viable options. Selling an ePHR service directly to patients via a commercial supplier had a negative impact on the utility of the service. This research also shows that it would be prudent to take patients’ ages and perceived health status into consideration when developing and marketing an ePHR service. Surprisingly, patients’ level of activation for self-management did not appear to play a major role in influencing their preferences for the attributes of the ePHR service framework identified in the study.