Patients’ valuation of the prescribing nurse in primary care: a discrete choice experiment

Abstract

Background Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners’ skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. Design Discrete choice experiment patient survey. Setting and participants Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. Main outcome measure Stated choice of consultation. Main results There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional’s attention to patients’ views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference. Discussion and conclusion Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study’s limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations.