OBJECTIVES

: The number of telemedicine experiments is increasing in France. However, cost-effectiveness studies on this topic face two main difficulties: a broad scope (multiple techniques and medical fields) and methodological difficulties (QALY fail to measure individuals' preferences on telemedicine; lack of a single criterion to synthesize multidimensional impact). Examining patient preferences would resolve these methodological issues and facilitate the success of telemedicine experiments. By setting up a discrete choice experiment (DCE), we sought to know renal transplant patients' preferences for teleconsultations versus face-to-face consultations, as well as explanatory factors.

METHODS

: A DCE with a two-alternative (+status quo) study design was developed. Data were collected from march to june 2014 in the University Hospital of Nantes from 68 kidney transplant patients. They had never tried out telemedicine before. Preferences of the four attributes of follow-up consultations (planning flexibility, consultation mode and total time required, risk of losing his graft and out-of-pocket costs) were evaluated by a conditional logit model with status quo specific constant.

RESULTS

: Planning flexibility (p<0.1), consultation mode (p<0.05), risk of losing his graft (p<0.05) and out-of-pocket costs (p<0.05) determined the decision to choose or not an alternative. Patients had a significant preference for teleconsultations whereas they had an aversion to a higher level of risk and cost. However, this preference for teleconsultations is strongly correlated with the total time - transport, waiting and consultation time - required to come for a consultation. The longer the total time required for consultation is, the more patients tended to prefer teleconsultations. The results depend on the individual characteristics too.

CONCLUSIONS

: This study provides new data on how patients perceive telemedicine. It determined the importance of each attribute in patient decision whether or not to choose such monitoring. These results should be taken into account to propose telemedicine projects adapted to patients' expectations.