Abstract
BackgroundDespite an increase in research devoted to primary care attributes, the patient benefits and educational aspects of broad scope practice of primary care physicians (PCPs) have not been well studied, due to a lack of validated measurement in each country. The objective of this study was to develop and validate the Scope of Practice Inventory (SPI) to measure physicians’ scope of practice within the Japanese primary care setting.MethodsThe questionnaire was developed in seven phases: 1) item generation, 2) consensus method for necessity of each item, 3) Delphi process for the importance of each item, 4) pilot tests to limit the number of items, 5) preliminary cross-sectional study to examine factor structure and to validate the construct validity, 6) evaluation of internal consistency and intra-class reliability, and 7) evaluation of external validity. To confirm the interpretability of the SPI, the determinants of the SPI using a generalized linear model were evaluated.ResultsAmong 359 items generated by a focus group, 180 reached a defined consensus on face and content validity after the Delphi process. After deletion of items with Kappa values less than 0.6, 120 items were selected for the preliminary study. The principle component analysis using responses from 451 PCPs eliminated 52 items. The final 68-point SPI had three subdomains: Inpatient care, 25 items; Urgent care and minor procedures, 27 items; and Ambulatory care, 16 items. Internal consistency and test-retest reliability for total SPI and each subdomain revealed acceptable reliability. Male sex, less years since graduation, working in a hospital, sub-urban or rural setting, having remote experience, and having board certification as a PCP were positively associated with higher SPI.ConclusionsWe developed a self-administered 68-point scale, the SPI, which had satisfactory validity and reliability. Primary care quality and educational research using SPI are expected to contribute to comprehensive and efficient health care systems in the future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0357-z) contains supplementary material, which is available to authorized users.
Highlights
Despite an increase in research devoted to primary care attributes, the patient benefits and educational aspects of broad scope practice of primary care physicians (PCPs) have not been well studied, due to a lack of validated measurement in each country
Study design The questionnaire was developed in seven phases: 1) A literature review, followed by a focus group with seven PCPs for the purpose of item generation, 2) a consensus method for necessity of each item, 3) a Delphi process with six other PCPs to gain consensus regarding the importance of each item and to evaluate the content validity of the questionnaire, 4) pilot tests to limit the number of items, 5) a preliminary questionnaire-based cross-sectional study to validate the construct validity of the questionnaire, 6) evaluation of internal consistency and intra-class reliability, and 7) evaluation of external validity
Subsequent Delphi process extracted 180 preliminary item pools related to scope of practice with good face validity that were thought to be important for PCPs
Summary
Despite an increase in research devoted to primary care attributes, the patient benefits and educational aspects of broad scope practice of primary care physicians (PCPs) have not been well studied, due to a lack of validated measurement in each country. Based on the 1978 Alma-Ata Declaration, the World Health Organization has proposed a global goal of achieving universal primary care with the following attributes: first contact care, person-centredness, comprehensiveness and integration, continuity of care, responsibility, and coordination [5]. Among these attributes, the influence of person-centredness [6], continuity [7, 8], and coordination [9] to health care outcomes have been well demonstrated.
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