Patient perceptions and expectations of an anticoagulation service: a quantitative comparison study of clinic-based testers and patient self-testers

Abstract

Background: Government initiatives see the provision of technology assisted self-care as one of the key areas in which there is capacity for improving quality of care whilst reducing costs. However, levels of patient engagement in self-testing and management remain low. Little emphasis has been placed on understanding the patients’ perspectives of the reasons for this limited engagement. Typically, patient engagement in self-testing and management is achieved via the provision of patient education programmes, which aim to enable patients to make the changes necessary to become competent self-carers. However, placing the onus to change on the individual patient is unrealistic. If levels of patient engagement are to be improved, patient needs and expectations of clinical services must be better understood and service provision must be adapted accordingly. Objective: Explore patient perceptions and expectations of clinical service provision and their views of having and making choices about care. Methods: Participants (N=191, 103 patient self-tester-managers (PSTMs) and 87 clinic-based testers (CBTs)) completed the SERVQUAL and ChQ instruments to capture perspectives on service quality and choice respectively. A comparative statistical analysis explored the similarities and differences between PSTMs’ and CBTs’ responses. Results: CBTs’ perceptions of service quality were significantly more positive than PSTMs’, as were their expectations of the ‘tangible’ aspects of service delivery. PSTMs’ expectations of service quality were significantly higher than their perceptions. PSTMs attributed significantly more value to making choices compared with CBTs. Conclusions and recommendations: To close the gap between PSTMs expectations and perceptions of service quality and better cater for their choice preferences, service providers may benefit from taking into account the following practice considerations: maintain frequent, timely, personalised and direct interactions with PSTMs; prioritise investment in resources to facilitate patient/practitioner interaction over tangible facilities; ensure that PSTMs are given the opportunity to make choices about their care.