Measurement of Primary Healthcare Attributes from the Patient Perspective

Abstract

This special issue of Healthcare Policy/Politiques de Sante presents a series of papers reporting on the concurrent validation of instruments that assess primary healthcare (PHC) delivery from the patient's perspective. The study was funded in 2004 by the Canadian Institutes of Health Research (CIHR) at the height of the Primary Health Care Transition Fund, an $8-million investment by Health Canada to catalyze a renewal of the PHC system in Canada. In planning the evaluation for initiatives, it became evident that program evaluators and researchers had little guidance for selecting among available instruments. For example, although various instruments purported to measure accessibility, it was not obvious that all measured the same underlying construct. Nor was it clear how to compare results collected with different instruments in different jurisdictions or at different times. This research program consists of three studies. The first is a consensus consultation of PHC experts across Canada to formulate operational definitions of attributes to be evaluated (Haggerty et al. 2007). Second, we mapped the operational definitions to validated instruments (available at www.programmeprecise.ca/en/publications). Third, we administered six instruments back-to-back in Nova Scotia and Quebec to adults with a regular source of care to examine and compare how well the instruments measure essential attributes of primary healthcare. We selected six instruments in the public domain that assess usual care rather than a single visit, that are generic (not limited to a specific patient group or dimension of care) and that had been most proposed or used in Canada: Primary Care Assessment Survey (PCAS) (Safran et al. 1998); Primary Care Assessment Tool – Short Form, adult (PCAT-S) (Shi et al. 2001); Components of Primary Care Index (CPCI) (Flocke 1997); First version of the European general practice evaluation instrument (EUROPEP-I) (Grol et al. 2000); Interpersonal Processes of Care – 18-item version (IPC-II) survey (Stewart et al. 2007); Veterans Affairs National Outpatient Customer Satisfaction Survey (VANOCSS) (Borowsky et al. 2002).