Mapping the coverage of attributes in validated instruments that evaluate primary healthcare from the patient perspective

Abstract

BackgroundPrimary healthcare in developed countries is undergoing important reforms, and these require evaluation strategies to assess how well the population's expectations are being met. Although numerous instruments are available to evaluate primary healthcare (PHC) from the patient perspective, they do not all measure the same range of constructs. To analyze the extent to which important PHC attributes are covered in validated instruments measuring quality of care from the patient perspective.MethodWe systematically identified validated instruments from the literature and by consulting experts. Using a Delphi consensus-building process, Canadian PHC experts identified and operationally defined 24 important PHC attributes. One team member mapped instrument subscales to these operational definitions; this mapping was then independently validated by members of the research team and conflicts were resolved by the PHC experts.ResultsOf the 24 operational definitions, 13 were evaluated as being best measured by patients, 10 by providers, three by administrative databases and one by chart audits (some being best measured by more than one source). Our search retained 17 measurement tools containing 118 subscales. After eliminating redundancies, we mapped 13 unique measurement tools to the PHC attributes. Accessibility, relational continuity, interpersonal communication, management continuity, respectfulness and technical quality of clinical care were the attributes widely covered by available instruments. Advocacy, management of clinical information, comprehensiveness of services, cultural sensitivity, family-centred care, whole-person care and equity were poorly covered.ConclusionsValidated instruments to evaluate PHC quality from the patient perspective leave many important attributes of PHC uncovered. A complete assessment of PHC quality will require adjusting existing tools and/or developing new instruments.

Informing the model of care for an academic integrative healthcare centre: a qualitative study exploring healthcare consumer perspectives

“…Studies have shown that communication, the patient-provider relationship, and preference-based care are important dimensions of person-centred care and SDM [62], and that strategies designed to increase SDM may have a positive impact on patient satisfaction [63] and health outcomes [60,61]. However, other dimensions of person-centred care, such as comprehensiveness of services, cultural sensitivity, and whole-person care, are not well researched [64]. Findings from our study suggest that, along with fostering SDM, IHC services may further support person-centred care by offering a diverse range of TCIM therapies that are culturally appropriate and holistic.…”

Assessment of primary health care received by the elderly and health related quality of life: a cross-sectional study

“…In the Spanish study items such as accessibility and doctor-patient relationship were higher in rural areas, less privileged populations, and among teams involved in the care of elderly [29]. Although PCATooL and other instruments used to evaluate the attributes of PHC do not incorporate the doctor-patient relationship and adoption of evidence-based practices, they included the core attributes [30]. …”

Barriers and facilitators for implementation of family medicine–oriented model of primary care in Bosnia and Herzegovina: A qualitative study

“…The strength of primary care system in one country is determined by the degree of development of 4 primary care structure and process dimensions (accessibility, comprehensiveness, continuity, and coordination) as well as the capacity to achieve a high‐quality professional care and cost‐effective health care system …”

“…12 The strength of primary care system in one country is determined by the degree of development of 4 primary care structure and process dimensions (accessibility, comprehensiveness, continuity, and coordination) as well as the capacity to achieve a high-quality professional care and cost-effective health care system. [13][14][15][16] To strengthen their primary care delivery systems, many countries have implemented health care reform, a process that included public engagement, political decisions, and significant financial resources. 2 The introduction of PHC reforms in the eastern European countries was particularly challenging because of significant reduction in health care financing, problems in organizational structures, or emigration of physicians to other countries.…”