Factorial validation of the patient assessment of chronic illness care (PACIC) and PACIC short version (PACIC-S) among cardiovascular disease patients in the Netherlands

Jane Cramm,Anna Nieboer

doi:10.1186/1477-7525-10-104

Abstract

ObjectiveThe Chronic Care Model (CCM) has achieved widespread acceptance and reflects the core elements of patient-centred care in chronic diseases such as cardiovascular diseases (CVD). In the Netherlands the extent to which CVD patients receive care congruent with the CCM is unknown. The main objectives of this study were to validate the 20-item Patient Assessment of Chronic Illness Care (PACIC) and the 11-item (PACIC-S) in the Netherlands among CVD patients and investigate the validity, reliability, and sensitivity to change of both instruments.MethodsThe Dutch version of the PACIC and PACIC-S were tested among 1484 CVD patients (out of 2760; response rate 54%) enrolled in Disease Management Programmes (DMPs) at T0 and 1167 respondents (out of 2545; response rate = 46%) at T1. Five hundred-eighty-five CVD patients filled in the questionnaire at both T0 and T1. We tested the instrument by means of structural equation modeling, and examined its construct validity, reliability and sensitivity to change. Reliability of the instrument was assessed by determining the statistical coherence of the scaled items. Internal consistency of the subscales was assessed by calculating Cronbach’s alphas and correlations between the PACIC and PACIC-S. We investigated the sensitivity to change of the original PACIC and the PACIC-S with paired t-tests among CVD patients in DMPs who filled in the questionnaire at both T0 and T1 (N = 585).ResultsThe confirmatory factor analyses revealed good indices of fit with the PACIC and PACIC-S. Internal consistency as represented by Cronbach’s alphas were also good. Correlations between the PACIC and PACIC-S subscales were excellent: 0.98 at both T0 and T1. Paired t-tests results show that the PACIC and PACIC-S improved significantly over time (p < 0.01).ConclusionsThe psychometric properties of the Dutch PACIC and PACIC-S were satisfactory and it is sensitive to change, rendering it a valid and reliable instrument for assessing chronic illness care among CVD patients.

Highlights

Chronic diseases such as cardiovascular diseases (CVD) are major causes of death and disability worldwide with rising prevalence [1]
We describe the psychometric testing of the Patient Assessment of Chronic Illness care” (PACIC) and PACIC-S among CVD patients enrolled in Disease management programmes (DMPs) participating in quality improvement projects focused on chronic care in the Netherlands
We investigated the sensitivity to change of the original PACIC and the PACIC-S among CVD patients who filled in the questionnaire at both T0 and T1 (N = 585) to assess its ability to accurately detect changes

Summary

Introduction

Chronic diseases such as cardiovascular diseases (CVD) are major causes of death and disability worldwide with rising prevalence [1]. They pose a significant health threat and an increasing challenge to health care systems [2]. Disease management programmes (DMPs) aim to improve the efficiency and effectiveness of chronic care delivery [10] by combining patient-related, professionallydirected and organisational interventions [12,13]. In the Netherlands, DMPs are often based on the Chronic Care Model (CCM) [14,15,16,17]. No data are available to date showing the extent to which current primary care for the CVD patients is CCM-compliant

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Conclusion