Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases

Abstract

Background: The aim of this study was to measure the patient’s perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement.Method: A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum of 12. Results: There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2 %), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 minutes. The average, median and mode of the consultation length were 8.5, 7.74 and 10 minutes, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p=0.022), and higher among those with more than 2 consultation interruptions (p=0.015) and those who knew the doctor very well (p=0.015). The PEI score was lower in patients with heart disease (p=0.022). The consultation length was longer in those with tertiary education (p=0.044) and those with two consultation interruptions (p=0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p<0.001). The consultation length correlated with the PPPC Average (ρ=0.168, p=0.025) . Conclusion: Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.