Patient preferences for community pharmacy service models in diabetes care: a discrete choice experiment

With the rising global prevalence of diabetes, traditional hospital-centered healthcare models are becoming increasingly inadequate to meet patients' long-term management needs. Community pharmacy services have the potential to address these gaps. However, systematic research on patient preferences for such services remains limited.

This study aimed to determine the factors influencing diabetic patients' preferences for community pharmacy service models using a discrete choice experiment (DCE), and to explore how these preferences vary according to glycemic control status.

Attributes and levels of DCE were identified through literature review, expert consultation, and patient pretesting. Six attributes were included: service content, service provider, follow-up program, reduction in cardiovascular events, reduction in hypoglycemic events, and service costs. A mixed orthogonal design generated 18 choice sets, with one scenario serving as reference. The survey was conducted face-to-face with patients with type 2 diabetes attending three community health service centers in Nanjing, China. Conditional logit models were applied to estimate attribute importance and subgroup analyses were performed based on HbA1c levels.

Of the 237 respondents, 190 provided valid responses (response rate: 80.1%). Across the overall sample, the most influential attributes were pharmacy service content (Wald = 389.188, relative attribute importance [RAI] = 4.59), followed by the frequency of hypoglycemic reactions (Wald = 284.155, RAI = 4.19), service cost (Wald = 168.079, RAI = 4.07), reduction in cardiovascular events (Wald = 144.608, RAI = 3.38), service providers (Wald = 142.913, RAI = 3.29), and follow-up programs (Wald = 50.644, RAI = 1.15). Patients preferred drug effectiveness assessments over counselling or adverse reaction monitoring, valued collaborative care involving pharmacists and physicians, and demonstrated willingness to pay approximately ¥20 per session. Subgroup analyses revealed that patients with HbA1c ≤ 8% were more cost-sensitive and favored fixed-interval follow-up, whereas those with HbA1c > 8% preferred individualized follow-up programs and placed less emphasis on service costs.

Patients with diabetes prioritize service quality, outcome-driven care, and multidisciplinary collaboration when selecting community pharmacy services. While hypoglycemia reduction and cost are important across groups, preferences vary according to glycemic control, highlighting the need for tailored patient-centered service models. These findings provide evidence to guide the development of sustainable and responsive community pharmacy services.