Abstract
BackgroundValidated instruments are needed to assess the delivery of patient-centred care (PCC) to patients with multimorbidity in the primary care setting. Eight dimensions of PCC have been identified: respect for patients’ preferences, access to care, emotional support, information and education, involvement of family and friends, continuity and secure transition between health care settings, physical comfort, and coordination of care. The main objective of this study was to validate an instrument for the assessment of PCC among patients with multimorbidity in the primary care setting: the 36-item patient-centred primary care (PCPC) instrument.MethodsWe included patients with multimorbidity from seven health care practices in the region of Tilburg, the Netherlands. All patients enrolled in at least two chronic care programmes (involving diagnosis of and treatment for combinations of diabetes, asthma and/or chronic obstructive pulmonary disease, cardiovascular diseases and conditions, and age-related frailty) were selected from the practices’ data registries and included as eligible participants. A total of 216 patients with multimorbidity filled in the study questionnaire (55% response rate). We tested the instrument using structural equation modelling, and examined its validity and reliability.ResultsConfirmatory factor analyses revealed good indices of fit and overall internal consistency, as represented by Cronbach’s alpha values. All eight dimensions of PCC were related positively to satisfaction with care (all p ≤ 0.001). Patients with multimorbidity who experienced joint decision making and responsibility taking in the primary care setting also had significantly higher scores for all eight PCC dimensions, indicating the instrument’s construct validity.ConclusionsWe conclude that the psychometric properties of the 36-item PCPC instrument are good. Based on these results the PCPC instrument seems a promising tool for the assessment of PCC among patients with multimorbidity in the primary care setting.
Highlights
Validated instruments are needed to assess the delivery of patient-centred care (PCC) to patients with multimorbidity in the primary care setting
The development of the patient-centred primary care (PCPC) instrument builts on our earlier work [30,31,32], in which we investigated the eight dimensions of PCC in hospital and long-term care settings, as well as adjusting them based on literature describing primary care for patients with multimorbidity (e.g. [22,23,24,25]) and consulting experts in the primary care setting when it comes to care for patients with multimorbidity
Construct validity All eight dimensions of PCC were related positively to satisfaction with care, indicating construct validity (Table 5)
Summary
Validated instruments are needed to assess the delivery of patient-centred care (PCC) to patients with multimorbidity in the primary care setting. The number of people with chronic diseases is increasing at an astonishing rate, making millions of patients reliant on primary care systems. Patients with multimorbidity are known to report even worse well-being and health outcomes than do individuals with single chronic conditions [2]. They are more likely to be hospitalised and are at greater risk of premature death than are patients with single chronic diseases [3, 4]. 50 million people in Europe have at least two chronic diseases, and this number is expected to grow as populations age
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