Comparing patients’ and other stakeholders’ preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries

Objectives: To measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries. Design: A discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity. Setting: Preference data collected in Austria(AT), Croatia(HR), Germany(DE), Hungary(HU), Netherlands(NL), Norway(NO), United Kingdom(UK). Participants: Patients with multimorbidity, partners & other informal caregivers, professionals, payers, policy makers. Main outcome measures: Preferences of participants regarding outcomes of integrated care described as health/wellbeing, experience with care, and cost outcomes, i.e., physical functioning, psychological wellbeing, social relationships & participation, enjoyment of life, resilience, person-centeredness, continuity of care, total costs. Each outcome had three levels of performance. Results: 5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological wellbeing, and continuity of care. Continuity of care also entered the top-three of professionals, payers and policy makers in four countries (AT, DE, HR, HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL, NO and higher weights to person-centeredness in AT, DE, ES, HU. Payers and policy makers assigned higher weights than patients to costs, but these weights were relatively low. Conclusion: The wellbeing outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision making, whereby efforts to improve wellbeing and person-centeredness should not divert attention from improving physical functioning.