Investigating older people’s preferences for an urgent care service: a discrete choice experiment

Background: Emergency and urgent care, where patients perceive the need for immediate access to medical advice or treatment, comprises a large and significant component of health care delivery. Older people are over-represented in Emergency Departments (ED) and over 55% are likely to be hospitalised with extended lengths of stay. To date, little research has been conducted to assess the needs and preferences of older people concerning alternative models of urgent care. The purpose of this study was to identify older people’s preferences for key characteristics of an urgent care service as an alternative to ED presentation using discrete choice experiment methods. 

Methods: Attributes and levels for the Discrete Choice Experiment (DCE) were informed by older people and health care professionals with recent ED experience. Attributes included waiting time for ED admission, knowledge and training of medical professionals, the extent to which the older person is treated holistically, how the physical environment is designed to best support older people, and the level of follow-up care received. The DCE was embedded within a larger survey to assess older people’s (aged >65 years) views and preferences for alternative models of emergency and urgent care. Data were analysed using conditional and mixed logit regressions. 

Results: Overall, 995 older people consented to participate and fully completed the DCE. Respondents attached the strongest relative importance to an urgent care service with reduced waiting times (within 2 hours of making the triple zero call), followed by medical professionals with specialist training in the care of older people, holistic support and regular communication updates, physical environment to support older people, and a comprehensive discharge summary and follow up. All of these attribute levels were highly statistically significant (p<0.001) in influencing preferences for the total sample and by subgroups reflecting key socio-demographic characteristics and emergency care experience. 

Conclusions: This study has identified older people’s preferences for key characteristics of an urgent care service as an alternative to ED presentation. The findings will inform policymakers and practitioners in the design and configuratiCon of an optimal urgent care service model from the perspective of older people.