Abstract
BackgroundContinuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems. The patient’s perspective is important to assess outcomes fully and this is challenging because generic measures of patient-perceived continuity are lacking. We investigate the Chao Perception of Continuity (Chao PC) scale to determine its suitability as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting.MethodsDesign and Setting: A questionnaire study embedded in a prospective observational cohort study of outcomes for patients following acute stroke.Participants: 168 community dwelling patients (58% male) mean age 68 years a minimum one year post-stroke. Functional status: Barthel Index mean =16.Intervention: A 23-item questionnaire, the Chao Perception of Continuity (Chao PC) scale, sent by post to their place of residence or administered face to face as part of the final cohort study assessment.Results310 patients were invited to participate; 168 (54%) completed a questionnaire.All 23 questionnaire items were entered into a Principal Component Analysis. Emergent factors from the exploratory analysis were (1) inter-personal trust (relational continuity); (2) interpersonal knowledge and information (informational and relational continuity) and (3) the process of care (managerial continuity). The strongest of these was inter-personal trust.ConclusionThe context-specific items in the Chao PC scale are difficult for respondents to interpret in a United Kingdom Primary Care setting resulting in missing data and low response rates. The Chao-PC therefore cannot be recommended for wider application as a general measure of continuity of care without significant modification.Our findings reflect the acknowledged dimensions of continuity and support the concept of continuity of care as a multi-dimensional construct. We demonstrate the overlapping boundaries across the dimensions in the factor structure derived. Trust and interpersonal knowledge are clearly identified as valuable components of any patient-perceived measure of continuity of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-014-0191-8) contains supplementary material, which is available to authorized users.
Highlights
Continuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems
[1] Connecting care over time for patients with multi-morbidity can be difficult in health care systems that are largely organised around treatment for individual diseases and care can become fragmented
In countries like the United Kingdom (UK) where Primary Care is well developed, the general practitioner is both the gateway to specialist services and the coordinator of care: referring patients at the outset; and monitoring them when they return to primary care for longer-term maintenance of care
Summary
Continuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems. We investigate the Chao Perception of Continuity (Chao PC) scale to determine its suitability as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting. Long term conditions present a major challenge for health care commissioners and providers in developed countries across the world. In countries like the United Kingdom (UK) where Primary Care is well developed, the general practitioner is both the gateway to specialist services and the coordinator of care: referring patients at the outset; and monitoring them when they return to primary care for longer-term maintenance of care. Much of the task of navigating the system and providing continuity of care for patients still remains with primary care practitioners
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