Outcome preferences of older people with multiple chronic conditions and hypertension: a cross-sectional survey using best-worst scaling

Hélène E Aschmann; Milo A Puhan; Craig W Robbins; Elizabeth A Bayliss; Wiley V Chan; Richard A Mularski; Renée F Wilson; Wendy L Bennett; Orla C Sheehan; Tsung Yu; Henock G Yebyo; Bruce Leff; Heather Tabano; Karen Armacost; Carol Glover; Katie Maslow; Suzanne Mintz; Cynthia M Boyd

doi:10.1186/s12955-019-1250-6

Outcome preferences of older people with multiple chronic conditions and hypertension: a cross-sectional survey using best-worst scaling

Health Qual Life Outcomes. 2019 Dec 19;17(1):186. doi: 10.1186/s12955-019-1250-6.

Authors

Hélène E Aschmann¹, Milo A Puhan¹, Craig W Robbins^{2

3

4

5

6}, Elizabeth A Bayliss^{7

8}, Wiley V Chan⁹, Richard A Mularski^{10

11

12}, Renée F Wilson¹³, Wendy L Bennett¹⁴, Orla C Sheehan¹⁵, Tsung Yu¹⁶, Henock G Yebyo¹, Bruce Leff¹⁵, Heather Tabano⁷, Karen Armacost¹⁷, Carol Glover¹⁷, Katie Maslow^{17

18}, Suzanne Mintz^{17

19}, Cynthia M Boyd²⁰

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
² Center for Clinical Information Services, Kaiser Permanente Care Management Institute, Oakland, CA, USA.
³ Kaiser Permanente National Guideline Program, Oakland, CA, USA.
⁴ Guidelines International Network, Board of Trustees, Denver, CO, USA.
⁵ Family Medicine, Colorado Permanente Medical Group, Denver, CO, USA.
⁶ Clinical Education MOC Portfolio, The Permanente Federation, Oakland, CA, USA.
⁷ Institute for Health Research, Kaiser Permanente, Denver, CO, USA.
⁸ Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁹ Kaiser Permanente Northwest, National Guideline Program, Portland, OR, USA.
¹⁰ The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
¹¹ Department of Pulmonary & Critical Care Medicine, Northwest Permanente, Portland, OR, USA.
¹² Oregon Health & Science University, Portland, OR, USA.
¹³ Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁴ Division of General Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
¹⁵ Division of Geriatrics and Gerontology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
¹⁶ Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁷ Division of Geriatrics and Gerontology, Patient and Caregiver Partner Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁸ Gerontological Society of America, Washington, District of Columbia, USA.
¹⁹ Family Caregiver Advocacy, Kensington, MD, USA.
²⁰ Division of Geriatrics and Gerontology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA. cyboyd@jhmi.edu.

Abstract

Background: Older people with hypertension and multiple chronic conditions (MCC) receive complex treatments and face challenging trade-offs. Patients' preferences for different health outcomes can impact multiple treatment decisions. Since evidence about outcome preferences is especially scarce among people with MCC our aim was to elicit preferences of people with MCC for outcomes related to hypertension, and to determine how these outcomes should be weighed when benefits and harms are assessed for patient-centered clinical practice guidelines and health economic assessments.

Methods: We sent a best-worst scaling preference survey to a random sample identified from a primary care network of Kaiser Permanente (Colorado, USA). The sample included individuals age 60 or greater with hypertension and at least two other chronic conditions. We assessed average ranking of patient-important outcomes using conditional logit regression (stroke, heart attack, heart failure, dialysis, cognitive impairment, chronic kidney disease, acute kidney injury, fainting, injurious falls, low blood pressure with dizziness, treatment burden) and studied variation across individuals.

Results: Of 450 invited participants, 217 (48%) completed the survey, and we excluded 10 respondents who had more than two missing choices, resulting in a final sample of 207 respondents. Participants ranked stroke as the most worrisome outcome and treatment burden as the least worrisome outcome (conditional logit parameters: 3.19 (standard error 0.09) for stroke, 0 for treatment burden). None of the outcomes were always chosen as the most or least worrisome by more than 25% of respondents, indicating that all outcomes were somewhat worrisome to respondents. Predefined subgroup analyses according to age, self-reported life-expectancy, degree of comorbidity, number of medications and antihypertensive treatment did not reveal meaningful differences.

Conclusions: Although some outcomes were more worrisome to patients than others, our results indicate that none of the outcomes should be disregarded for clinical practice guidelines and health economic assessments.

Keywords: Best-worst scaling; Hypertension; Multiple chronic conditions; Outcome preferences; Patient preferences.

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Decision Making*
Female
Humans
Hypertension / complications
Hypertension / psychology*
Male
Middle Aged
Multiple Chronic Conditions / psychology*
Patient Preference / economics
Patient Preference / psychology*
Quality of Life
Surveys and Questionnaires

Grants and funding

ME-1310-07619/PCORI/Patient-Centered Outcomes Research Institute/United States