What matters most to the population in case of chronic conditions? Results from a discrete choice experiment in Italy

Relational continuity, care coordination, and teamwork are widely recognized as key components of quality in primary care. This study investigates population preferences regarding organizational models of primary care, with a particular focus on the roles of general practitioners, specialists, and nurses. A Discrete Choice Experiment (DCE) was conducted through a nationwide online cross-sectional survey, employing a full factorial experimental design with 20 randomly selected choice sets to minimize cognitive burden. The attributes examined included coordination, relational continuity, and teamwork. Data were collected from a representative sample of 2,553 respondents across Italy in early 2021. Results underscore the centrality of teamwork (OR=1.85 in mild and 2.31 in severe chronic conditions), followed by relational continuity (OR=1.60 in mild and 1.55 in severe conditions). Coordination ranks third (OR=1.31) for mild conditions but reaches parity with relational continuity in the context of severe chronic conditions. These findings offer robust evidence of differentiated preferences based on chronic disease severity and support the design of tailored primary care models. In conclusion, this analysis highlights the importance of incorporating coordination, relational continuity, and teamwork in the configuration of primary care services, offering policy-relevant insights for adapting delivery models to the needs of patients with varying levels of chronicity.