Differences in waiting list prioritization preferences of occupational therapists, elderly people and persons with disabilities: a discrete choice experiment

Publication date: Available online 7 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Marie-Hélène Raymond, Louise Demers, Debbie E. Feldman
ObjectiveTo compare the preferences of occupational therapists, elderly people and adults with disabilities regarding prioritization criteria for occupational therapy waiting lists in home care.DesignDiscrete choice experiment survey. Respondents completed eight choice tasks where they were asked to choose which of two referral scenarios should be prioritized for services. Scenarios varied in terms of four attributes reflecting competing issues that come into play in waiting list prioritization: the person's ability to shower, ability to enter and exit the home, history of falls and time already spent on the waiting list.SettingThe survey was mailed to occupational therapists working in home care and community-dwelling elderly or disabled persons.InterventionsNot applicable.Participants241 home-based occupational therapists, 226 elderly persons from a bank of research participants and 247 adults with physical disabilities recruited through community organizations.Main outcome measuresThe dependent variable was whether the referral scenario was prioritized or not in each question. Results were analyzed through logistic regression using conditional logit models.ResultsPrioritization preferences differed between groups (p < 0.001). Occupational therapists most strongly prioritized people who had had a few falls (OR vs. no falls = 48.9) whereas elderly people and adults with disabilities most strongly prioritized people who were unable to enter and exit the home (OR vs. no difficulty entering and exiting the home = 30.8 for elderly people and 16.9 for persons with disabilities.)ConclusionsOur results highlight the gap between the priorities of home-based occupational therapists and their target clientele. Although further inquiry is needed to inform priority-setting, the findings emphasize the importance of public or patient involvement in decisions on waiting list prioritization.



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