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

Hill, Kate M.; Twiddy, Maureen; Hewison, Jenny; House, Allan O.

Abstract

Background: 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. 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.
Methods: Design 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.
Results: 310 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.
Conclusion: The 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

Citation

Hill, K. M., Twiddy, M., Hewison, J., & House, A. O. (2014). Measuring patient-perceived continuity of care for patients with long-term conditions in primary care. BMC family practice, 15(1), Article 191. https://doi.org/10.1186/s12875-014-0191-8

• Journal Article Type: Article
• Acceptance Date: Nov 10, 2014
• Online Publication Date: Dec 5, 2014
• Publication Date: 2014-12
• Deposit Date: Dec 11, 2017
• Publicly Available Date: Dec 15, 2017
• Journal: BMC Family Practice
• Print ISSN: 1471-2296
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 1
• Article Number: 191
• DOI: https://doi.org/10.1186/s12875-014-0191-8
• Keywords: Family Practice
• Public URL: https://hull-repository.worktribe.com/output/500029
• Contract Date: Dec 11, 2017