Preferences for community-based asynchronous-review eye clinics in the UK: A discrete choice experiment among patients, healthcare professionals, and the public
- 1Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- 2Research Department of Behavioural Science and Health, University College London, London, United Kingdom
- 3National Institute for Health and Care Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
Abstract
The United Kingdom government’s 10 Year Health Plan for England sets out three shifts for a future-ready health service in England: shifting care from hospitals to communities, harnessing technology in health and care, and prioritising prevention over treatment. In this spirit, a large eye-hospital network in central London piloted a community-based, technician-led, asynchronous/virtual-review clinic to monitor stable chronic eye conditions and reduce avoidable harms, a model which could supplement traditional clinician-led services. Understanding stakeholder preferences around services is crucial for future planning and scaling. This paper describes a national survey examining key attributes for services monitoring chronic eye disease and calculating their relative importance for key stakeholders in the UK. We developed a discrete choice experiment (DCE) and distributed it electronically across the UK, targeting ophthalmology patients, healthcare professionals (HCP), and the public, asking all to respond from a patient’s perspective due to logistical and analytical considerations. Conditional logistic regression estimated the strength of stated preferences and trade-offs stakeholders would make between attributes, expressed as willingness to wait (WTW) longer than planned for their next appointment and willingness to travel (WTT) longer to the appointment location. Other attributes included whether a clinician or technician led the tests and how results were communicated (combined into single attribute reflecting service realities), venue accessibility by public transport, and parking. We received 389 responses, and the attribute describing who the patient saw and how results were received was the most important for all three groups. Compared to seeing a clinician with same-day results, respondents required appointment delay reductions of 6.27 months (95%CI 4.52–8.03) or travel reductions of 153 minutes (95%CI 88–219) if seeing a technician and receiving results by post, or smaller reductions if seeing technician then receiving results by phone. Differences across the respondent groups are discussed. This work suggests that technician-led asynchronous-review ophthalmology services could acceptably supplement clinician-led models, provided they improve appointment delays and reduce travel time. Therefore, service designers should align with these preferences when planning new services.
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BibTeX
@article{ndwandwe2026preferences,
title = {{Preferences for community-based asynchronous-review eye clinics in the UK: A discrete choice experiment among patients, healthcare professionals, and the public}},
author = {Siyabonga Ndwandwe and Angus I. G. Ramsay and Josefine Magnusson and Steve Napier and Helen Baker and Jocelyn Cammack and Dun Jack Fu and Peng Tee Khaw and Sobha Sivaprasad and Hari Jayaram and Paul J. Foster and Caroline S. Clarke and on behalf of the HERCULES Consortium},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0342133},
url = {https://doi.org/10.1371/journal.pone.0342133},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Preferences for community-based asynchronous-review eye clinics in the UK: A discrete choice experiment among patients, healthcare professionals, and the public
AU - Siyabonga Ndwandwe
AU - Angus I. G. Ramsay
AU - Josefine Magnusson
AU - Steve Napier
AU - Helen Baker
AU - Jocelyn Cammack
AU - Dun Jack Fu
AU - Peng Tee Khaw
AU - Sobha Sivaprasad
AU - Hari Jayaram
AU - Paul J. Foster
AU - Caroline S. Clarke
AU - on behalf of the HERCULES Consortium
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0342133
UR - https://doi.org/10.1371/journal.pone.0342133
AB - The United Kingdom government’s 10 Year Health Plan for England sets out three shifts for a future-ready health service in England: shifting care from hospitals to communities, harnessing technology in health and care, and prioritising prevention over treatment. In this spirit, a large eye-hospital network in central London piloted a community-based, technician-led, asynchronous/virtual-review clinic to monitor stable chronic eye conditions and reduce avoidable harms, a model which could supplement traditional clinician-led services. Understanding stakeholder preferences around services is crucial for future planning and scaling. This paper describes a national survey examining key attributes for services monitoring chronic eye disease and calculating their relative importance for key stakeholders in the UK. We developed a discrete choice experiment (DCE) and distributed it electronically across the UK, targeting ophthalmology patients, healthcare professionals (HCP), and the public, asking all to respond from a patient’s perspective due to logistical and analytical considerations. Conditional logistic regression estimated the strength of stated preferences and trade-offs stakeholders would make between attributes, expressed as willingness to wait (WTW) longer than planned for their next appointment and willingness to travel (WTT) longer to the appointment location. Other attributes included whether a clinician or technician led the tests and how results were communicated (combined into single attribute reflecting service realities), venue accessibility by public transport, and parking. We received 389 responses, and the attribute describing who the patient saw and how results were received was the most important for all three groups. Compared to seeing a clinician with same-day results, respondents required appointment delay reductions of 6.27 months (95%CI 4.52–8.03) or travel reductions of 153 minutes (95%CI 88–219) if seeing a technician and receiving results by post, or smaller reductions if seeing technician then receiving results by phone. Differences across the respondent groups are discussed. This work suggests that technician-led asynchronous-review ophthalmology services could acceptably supplement clinician-led models, provided they improve appointment delays and reduce travel time. Therefore, service designers should align with these preferences when planning new services.
SN - 1932-6203
ER -