Dissertation
Patient preferences and willingness-to-pay for Medicare part D consultations offered in a community pharmacy setting
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2022
DOI: 10.25820/etd.006449
Abstract
Introduction: Community pharmacies across the state of Iowa currently offer Medicare Part D consultation services. Despite an increase in plan-switching behavior, potential cost savings, and increased medication adherence resulting from service use, uptake of these services by patients remains low. Objectives: The objectives of this study were to 1) explore patient-centeredness and patient preferences for Medicare Part D consultation service offerings from the perspective of patients. 2) calculate part worth utilities and willingness-to-pay (WTP) for specific service offerings as well as marginal willingness-to-pay (mWTP) for individual service offering attributes, and 3) evaluate the effect of patient-specific factors on optimal service offerings and patient preference for Medicare Part D services.
Methods: This was a multi-phase exploratory mixed method study using qualitative interviews and a discrete choice experiment (DCE) survey. Participants for qualitative interviews were recruited by five Iowa CPESN pharmacies and were patients 65 years of age and older who had and had not previously used a Medicare Part D consultation service. A qualitative interview guide was developed using the SERVQUAL framework adapted for healthcare services, with questions focused on Technical, Interpersonal, Administrative, and Environmental quality. Interview transcripts were transcribed and coded using Template analysis, with attributes and levels developed for a (DCE). Qualtrics was contracted to acquire 540 DCE survey responses from individuals who were 65 years of age and older, who currently use one or more prescription medications from a community pharmacy. Demographics and patient-specific factors contributing to patient preference were reported as descriptive statistics. A mixed logit model was used to calculate part-worth utilities for service attributes. To calculate mWTP, the ratio of part-worth utilities to cost was used, with cost treated as a continuous variable. To evaluate patient-specific factors and demographics which may contribute to patient preference for Medicare Part D consultation service offerings, a latent class model was used.
Results: In total, 17 interviews were completed (8 service experienced, 9 service naive), with themes identified to design the Qualtrics DCE Survey. The overall themes associated with each SERVQUAL domain were as follows: Technical Quality (), Interpersonal Quality (), Administrative Quality (), and Environmental Quality () In the final DCE instrument, the service attributes that were tested included: Information Provided, Service Location, Service Provider, Service Length, and Price. From the results of the DCE, 540 responses were collected, with the average of respondents being 71 years. For the initial choice task designed as a dominant scenario, 481 respondents (89.07%) selected the dominant choice. Most respondents were female (60%), lived in a Suburban area (56%), used one pharmacy in the past 30 days (76%), were currently taking four or more prescription medication (51%), had previously used a pharmacy service outside of traditional medication dispensing (60%), and most frequently used a chain pharmacy (51%). Overall, self-reported health activation was high with an average of 7.52±1.92. The average scores for the subcomponents of the adapted Medicare Part D health insurance literacy items were 13.9±4.1 and 13.81±2.57, respectively. Service attributes with the highest utility were 15-minute services, discussion of services + a follow-up phone call, In person at the pharmacy, a pharmacist the patient knew, and at no cost. Latent class analysis revealed that patient preferences for service attributes differed by gender and difficulty affording prescription medications.
Conclusion: Overall, patients identified pharmacists as potential resources for providing Medicare Part D consultation services, with preferences for specific service attributes. From the DCE survey, patients have specific preferences for service offerings which were quantified using part-worth utilities. Community pharmacies should consider the service attributes associated with utility when considering their Medicare Part D consultation service offerings.
Details
- Title: Subtitle
- Patient preferences and willingness-to-pay for Medicare part D consultations offered in a community pharmacy setting
- Creators
- Logan Thomas Murry
- Contributors
- Julie M Urmie (Advisor)Matthew J Witry (Committee Member)William R Doucette (Committee Member)Dhananjay Nayakankuppam (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Pharmacy
- Date degree season
- Summer 2022
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.006449
- Number of pages
- xvi, 223 pages
- Copyright
- Copyright 2022 Logan Thomas Murry
- Language
- English
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (pages 136-164).
- Public Abstract (ETD)
Older individuals often have difficulty selecting Medicare Part D insurance plans to cover their prescription medications. Identifying this difficulty, community pharmacies across the country have begun offering insurance consultation services to assist individuals in their prescription medication insurance plan selection. Despite potential benefits of using these services, uptake and repeated use of these services remains low. Currently, little is known about how these consultation services are delivered at the community pharmacy level. While individual pharmacies have developed and implemented these services, service offerings vary across pharmacies and are infrequently designed to accommodate patient-specific abilities and preferences. Additionally, these services are almost always offered at no-cost to patients despite resources and staffing required to provide them. To increase the use and sustainability of Medicare Part D consultation services offered in the community pharmacy setting, a thorough evaluation of patent-preferences for service offerings as well as exploration of potential willingness-to-pay for such services should be performed.
This project used interviews and surveys to identify components of Medicare Part D consultation services that patients preferred and associated with value. These perspectives were gathered from individuals who had both used and not used a consultation service provided in the community pharmacy. Following the interviews and survey, a stated preference instrument was used to present individuals with a wide variety of service offering “bundles” or service offerings with attributes varying across five different service attributes: information provided, duration of service, location of service, service provider, and cost. Preference and willingness-to-pay for each attribute were calculated and used to inform an optimal service bundle.
The results of the stated preference study identified patient preferences and willingness-to-pay for a Medicare Part D consultation service, with the preferred service offering reflecting the following service attributed: 15 minutes in duration, provide in person at the pharmacy by a pharmacist the patient knew, with a discussion of plans and a follow-up phone call, offered at no-cost. Preference for and importance of these attributes were different based on gender and difficulty affording prescription medications. The results of this study can help community pharmacies develop and expand existing Medicare Part D consultation services to maximize sustainability while accommodating patient preferences for enhanced service offerings.
- Academic Unit
- Pharmacy
- Record Identifier
- 9984285454002771
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