Measuring continuity of ambulatory cardiovascular care: a cross-sectional study on the applicability of the Nijmegen Continuity Questionnaire in Germany

Abstract

Background Chronic cardiovascular diseases demand continuous care from general practitioners and medical specialists. Especially in fragmented healthcare systems, such as in Germany, a large body of research is devoted to the improvement of care continuity. Meanwhile, measuring continuity of care itself has been a challenge due to the absence of validated instruments. In 2011, the Dutch Nijmegen Continuity Questionnaire (NCQ) was developed and validated to measure continuity of care across care settings from the patients’ perspectives in the Netherlands. Its applicability in other countries and health systems, however, has rarely been tested. We therefore aimed at assessing the applicability of the Nijmegen Continuity Questionnaire to the German health care context. Methods We translated and applied the original NCQ to an ambulatory cardiovascular care setting in Germany. Qualitative interview data and quantitative survey data on our adaptation were collected from patients in 27 general practices within the German states of Baden-Wuerttemberg and Rhineland-Palatinate. Qualitative data on understandability and clearness of the questionnaire was obtained using semi-structured telephone interviews and think aloud-protocols. Quantitative data was obtained through an anonymous written questionnaire containing the translated NCQ items to assess applicability of our translation. We performed confirmatory and exploratory factor analyses based on the original NCQ-structure mapped to general practitioners and an aggregated analysis of general practitioners and cardiologists combined. Results A total of 6 patients participated in the interviews and a total of 435 patients participated in the written survey. The interviews showed that, overall, patients had little difficulties comprehending and answering to our translation of the NCQ. The confirmatory factor analyses then showed that the structure of the original NCQ with 12 items and 3 latent factors can also be found in the German context. However, a simpler 2-factor-structure would also fit well with the data. Conclusion A German translation of the NCQ yielded a factor structure comparable to the original version and proved to be understandable for patients. Trial registration The project underlying the study was registered on November 7, 2019 in the German Clinical Trials Register (www.drks.de) under ID: DRKS00019219.

Continuity of primary care for type 2 diabetes and hypertension and its association with health outcomes and disease control: insights from Central Vietnam

“…The NCQ was developed by Uijen AA et al (2012) [ 36 ], validated in different countries [ 24 , 38 – 40 ] and mainly applied in the out-patient, primary and secondary care settings. The Vietnamese version of this instrument was validated by forward and backward translating and testing to verify if the translation was correct and appropriate to the Vietnamese context.…”

Influence of Cooperation Work on Management Continuity of Ambulatory Cardiovascular Care: A Cross-Sectional Exploratory Study in Germany

“…After the independent translations, consensus discussions were held and a common German version was produced. A test involving interviews with six patients did not identify any significant lack of clarity [24]. For this part of the project, we used only the scales for team and cross-boundary continuity, which served as the outcomes of the study.…”