Measuring patient-perceived continuity of care for patients with long-term conditions in primary care

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.

Introducing community integrated nursing teams: How one Clinical Commissioning Group applied an evidence-based approach

“…In a systematic review exploring the link between depression and access to urgent care it was found that patients with depression were more likely to access urgent care (Dickens et al 2012). Also, Hill et al (2014) found in a study on patient perception of continuity of care in the community that the frequency and duration of healthcare contact was also affected by emotional factors. Despite this link, health care professionals are not always able to assess and support people with such challenges (Tee & Bockle 2012) and patients report that they need to be in a state of crisis before access to mental health services is granted (Ross et al 2014).…”

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“…Continuity of care refers to the degree to which a series of discrete healthcare events are experienced as coherent, connected and consistent with the patient's medical needs and personal context (Hill, Twiddy, Hewison, & House, 2014). A patient pathway can be explained as a chronologic chain of events comprising patient encounters with different healthcare systems (Report no 47, 2008(Report no 47, -2009).…”

Validation of the OPportunity for Treatment In ONcology (OPTION) questionnaire measuring continuity of care

“…There is a consensus that continuity of care is a multi-dimensional construct (Haggerty et al, 2003). Consistent with this theoretical as- Hill et al (2014). These authors, using the Chao-PC, a 23-item questionnaire (Chao, 2016) in 310 stroke survivors, identified "interpersonal trust in the their doctors" as a key dimension in continuity of care, in addition to "interpersonal knowledge and information" and "providing consistent care."…”

“…It includes the ability of health care staff to be empathic, to listen and to engage patients in a trustful and respectful relationship. Trust is an important attribute of medical care and evidence shows that it can influence patients' engagement with care processes and their satisfaction with care (Trachtenberg, Dugan, & Hall, 2005) (Haggerty, Roberge, Freeman, & Beaulieu, 2013) (Hill, Twiddy, Hewison, & House, 2014), promoting more active patient roles such as seeking care and adhering to treatment regimens. Our finding are consistent with those of Hill et al (2014).…”

“…Trust is an important attribute of medical care and evidence shows that it can influence patients' engagement with care processes and their satisfaction with care (Trachtenberg, Dugan, & Hall, 2005) (Haggerty, Roberge, Freeman, & Beaulieu, 2013) (Hill, Twiddy, Hewison, & House, 2014), promoting more active patient roles such as seeking care and adhering to treatment regimens. Our finding are consistent with those of Hill et al (2014). These authors, using the Chao-PC, a 23-item questionnaire (Chao, 2016) in 310 stroke survivors, identified "interpersonal trust in the their doctors" as a key dimension in continuity of care, in addition to "interpersonal knowledge and information" and "providing consistent care."…”