Purpose: Making decisions about using medications during pregnancy, particularly anti-depressants, requires appropriate information. It is not known what format is preferred for receiving counseling and information services on medication use during pregnancy. Two common sources are family doctors and teratology information services (TIS, which operate specialized telephone hotlines).The purpose was to determine public preferences for attributes of teratology counseling on anti-depressant use during pregnancy.
Method: We designed a survey to assess preferences for counseling and administered it to a community sample. Attributes and levels were generated in focus groups. Based on attribute ratings and analysis of discussion themes, five attributes (training of information provider (IP), method of counseling and waiting time, knowing the IP, confidence in the IP and helpfulness of information), with two levels each and a cost attribute with three levels were selected. Sawtooth® was used to test and select a fractional factorial design that maximized D-efficiency and achieved orthogonality, minimal level overlap, and level balance. Three versions were generated, each with 12 random choice pairs and three fixed choice pairs (for testing rationality and consistency). Pilot testing showed that the survey was robust. Logistic regression was conducted in SAS to estimate utilities and significance.
Result: 175/203 volunteers completed the survey (85% women). All beta estimates were statistically significant. The most important attribute was receiving very helpful information (beta 0.72, 95% CI 0.52-0.92). Features of TIS were generally preferred over features of an encounter with a doctor, i.e. counseled via telephone (beta 0.23, 95% CI 0.07-0.39) by a non-physician specialist in medication use during pregnancy (beta 0.13, 95% CI 0.01-0.26). It was preferred, however, to speak with a provider who was known to the user (beta 0.53, 95% CI 0.41-0.65). Willingness to pay was affected by demographic factors, including education level and level of anxiety about being exposed to anti-depressants.
Conclusion: Given the preferred features of information service delivery found in this survey, counseling by a TIS likely offers the most benefit. The public valued high quality information and preferred receiving information in non-traditional formats (i.e. over the telephone with a non-physician), however, some sort of relationship with the HCP is still important. Preference information can be used to inform service design, and WTP values may be used in a future cost-benefit analysis.
Candidate for the Lee B. Lusted Student Prize Competition