Search

Patient choice is at the heart of health-care reform programmes in the UK and in many other countries. The success of patient choice initiatives is dependent on a well-functioning agency relationship in health care. We interviewed 197 patients from 13 general practices in the West Midlands, UK, both before and after coronary screening. Our study suggests that, for patients presenting for coronary risk screening in primary care, the agency relationship is not working well--patients' expressed preferences relating to decisions to commence drug treatments were largely over-ridden in the clinical consultation. Therefore, if choice is to be a real driver of change in health care it needs to encompass patient empowerment and be based on a more collaborative approach to decision making between patients and professionals.

Objectives: To determine the relationship between expressed preferences for drug treatment to prevent coronary disease and several participant and general practitioner characteristics among patients attending coronary risk screening., Design: Face-to-face interviews with patients. At the first interview, a researcher asked participants to imagine six scenarios representing different levels of pretreatment five-year coronary risk. In each case they were asked whether they would choose treatment that would reduce their coronary risk by 30% of pretreatment risk. At the second interview participants were told their coronary risk and asked whether they would choose treatment. Sociodemographic variables were collected to investigate their relationship to patients' treatment preferences., Participants: Patients identified as likely to be at high coronary risk were invited to attend for risk screening and to participate in the study., Setting: 13 practices in the West Midlands., Results: Participants' preferences varied widely: at the first interview 112 (55.2%) of 203 participants preferred treatment at 3% five-year coronary risk but 31 (15.3%) preferred no treatment even at 30% five-year coronary risk. Age, sex, education and drug treatment history did not affect preferences, but lower social class was associated with preferring treatment at lower risk. Preferences expressed at the second interview were generally consistent with preferences at the first interview (kappa = 0.510, 95% CI 0.380 to 0.639)., Conclusions: Patients attending for coronary risk screening express stable preferences for drug treatment to prevent coronary heart disease. Their preferences vary widely and may be associated with social class.