• Leti van Bodegom-Vos, Judith D de Jong, Peter Spreeuwenberg, Emile C Curfs, and Peter P Groenewegen.
• Netherlands Institute for Health Services Research (NIVEL), Utrecht and Department of Medical Decision Making, Leiden University Medical Centre, the Netherlands. l.vanbodegom-vos@lumc.nl
• Qual Prim Care. 2013 Jan 1;21(2):81-95.

BackgroundTo improve the feasibility of shifting medical specialist to general practitioner (GP) services in patient-centred health care systems, it is important to know how this substitution is valued by patients. However, insight into patients' preferences is lacking.AimThis study aims to fill this gap by assessing whether patients' preferences for substitution are related to the type of medical intervention.MethodsQuestionnaires were sent to 1000 members of the Dutch Insurants Panel (potential patients). Panel members were asked about their preferences for and use of medical specialist and GP services regarding 11 medical interventions. Six hundred and ninety-four members (69%) responded. We used multilevel multinomial regression to analyse the data.ResultsPreferences were significantly related to medical intervention type. GP services were preferred for follow-up treatments (e.g. removing stitches) and non-complex invasive treatments (e.g. removal of lumps), and medical specialist services were preferred for complex invasive treatments (e.g. injection therapy for varicose veins), non-invasive treatments (e.g. start of insulin therapy) and diagnostic examinations (e.g. abdominal ultrasound). Age, effort required to visit a GP, perceived health status and previous treatment experiences also influenced preferences but did not confound the effects of medical intervention type.ConclusionThis study provides strong indications that patients' preferences for substitution are influenced by the type of medical intervention. Therefore it seems important that health policy makers, purchasers and practitioners take the preferences of (potential) patients into account.

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