Quantifying patient preferences for inpatient pharmacist consultation: a multi-center discrete choice experiment in...

Pharmaceutical services play a critical role in safeguarding medication safety and optimizing therapeutic outcomes. Their value is increasingly recognized in China, where recent policy reforms have introduced new medical service pricing items, and several provinces have piloted an inpatient consultation fee (clinical pharmacy surcharge), namely inpatient pharmacist consultation (IPC), as a billable services.

This study used a discrete choice experiment (DCE) to evaluate hospitalized patients' preferences for IPC and the factors shaping these choices, providing evidence to inform service development and policy-making.

Study attributes and levels were derived from literature review, patient surveys, and expert interviews. Attributes included hospital tier (tertiary vs. non-tertiary), pharmacist professional title (attending pharmacist, associate chief pharmacist, chief pharmacist), consultation frequency (once, three times, five times per week), duration (5, 10, 15 min), service outcome (improved efficacy vs. reduced medication errors), and unit cost (10 or 15 CNY per session; 1 CNY ≈ 0.15 USD). A DCE questionnaire was administered to inpatients across six Sichuan hospitals. Preferences were analyzed using a mixed logit model to estimate regression coefficients (β) and willingness-to-pay (WTP).

Of 320 valid responses, patients preferred consultations delivered by associate chief pharmacists (β = 0.182, p < 0.001; WTP 5.00 CNY) in tertiary hospitals (β = 0.138, p < 0.001; WTP 3.80 CNY), with a primary focus on reducing medication errors (β = 0.125, p = 0.002; WTP 3.42 CNY). Patients favored three sessions per week (β = 0.156, p = 0.005; WTP 4.29 CNY) lasting 15 min each (β = 0.133, p = 0.016; WTP 3.65 CNY). Service cost had a limited negative influence on choices (β = -0.036, p < 0.001) within the narrow price range of 10 to 15 CNY tested in this study. The optimal profile (associate chief pharmacist, tertiary hospital, three times per week, 15 min/session, error reduction focus, 10 CNY/session) achieved a 68.4% predicted choice probability. Subgroup analyses showed that low-income patients prioritized consultation frequency, urban patients preferred longer duration, and patients with chronic diseases emphasized efficacy over error reduction.

Inpatients demonstrated clear preferences for attributes of IPC, with variations by income, residence, and chronic disease status. Greater involvement of clinical pharmacists, tailored adjustment of consultation frequency and duration, and integration into hierarchical diagnosis and treatment and chronic disease management were encouraged. Price has limited influence on choices. We recommend including pharmaceutical consultations in health insurance reimbursement after pilot programs.