Patient Assessment of Chronic Illness Care (PACIC) in Type 2 Diabetes: A Longitudinal Study

The association between Patient Assessment of Chronic Illness Care Scores and quality of life in type 2 diabetes patients

Background

Chronic illness care is an important factor for health promotion in diabetes since it affects health outcomes such as quality of life.

Aims

The aim of this study was to investigate the relationship between the Patient Assessment of Chronic Illness Care and the quality of life in type 2 diabetes patients.

Methods

The study used a cross-sectional and correlational design. The sample included 317 patients with type 2 diabetes. A socio-demographic and disease-related questionnaire form, the Patient Assessment of Chronic Illness Care (PACIC) scale and the WHOQOL-BREF Quality of Life Scale were used to collect data.

Results

According to the regression analysis, the stronger predictor affecting all domains of quality of life was the overall PACIC. This study demonstrated the importance of satisfaction level of chronic illness care in the improvement of quality of life. Therefore, the factors affecting the satisfaction level with chronic care services should be determined to improve the quality of life of patients. In addition, healthcare based on the chronic-care model should be provided in the care of the patients.

Conclusions

PACIC had an important effect on quality of life of the patients. This study demonstrated the importance of satisfaction level on chronic illness care in the improvement of quality of life.

Reform of the Health Insurance Funding Model to Improve the Care of Noncommunicable Diseases Patients in Saudi Arabia

Health insurance models are being considered as part of health system reforms in Saudi Arabia. This paper assesses the attributes of health funding models that support better control of non-communicable diseases (NCDs) and perspectives on health insurance as a model from the perspective of patients, clinicians, and managers. The study employed a mixed-methods research design that included quantitative and qualitative data gathering and analysis. Study findings indicated concerns that the current health funding mechanism is financially unsustainable and, as a result, there will be a greater reliance on personal health insurance to support government spending on healthcare. Essential elements of any health insurance model to support effective NCD management identified from a review of the literature and interviews include the following: ensuring continuity of care and equity; funding chronic disease prevention interventions; prioritising primary healthcare; and maintaining the principle of community rating to prevent insurers from discriminating against members. Other desirable attributes for the funding model includes collaboration across primary, secondary, and tertiary care. Healthcare finance reform aimed at adopting and increasing personal health insurance coverage may play a critical role in extending access to healthcare, eliminating health inequities, enhancing population health, and reducing government spending on healthcare if appropriately considered.

Patients' Assessment of Chronic Illness Care (PACIC): Validation and Evaluation of PACIC Scale among Patients with Type 2 Diabetes in Hungary

Introduction:

The aims of this study were to evaluate the psychometric properties of the Hungarian translation of the PACIC in a sample of patients with type 2 diabetes and to reveal the associations between the mean PACIC scores and the number of chronic diseases, or visits to GPs, and specialist. An exploratory factor analysis (EFA) has also been performed to test the structural validity of the PACIC scale.

Methods:

The Hungarian version of PACIC was validated using randomly selected patients with type 2 diabetes (N = 684) from licensed GP practices.

Results:

Floor (1.6%–30.2%) and ceiling effects (11.3–33.6%) were similar of the PACIC scale. The internal consistency of the total scale (Cronbach’s alpha 0.93) was excellent and subscales were good (between 0.73–0.9). The mean scores of each PACIC subscale group were between 2.99–3.53. There was a weak significant correlation between the mean PACIC scores of subscales and the number of GP visits (p < 0.001), and specialist visits (p < 0.001). The EFA identified four factors on the sample (KMO = 0.931). Gender and education showed correlation with some new factors.

Conclusion:

The psychometric properties of the Hungarian version of PACIC questionnaire showed a reasonable level of validity among patients with type 2 diabetes. Now, this instrument is ready to assess the chronic care of diabetic patients in Hungary.

Psychometric Properties and Effects on Health Outcomes of the Patient Assessment of Chronic Illness Care (PACIC) in Korean Hemodialysis Patients

Background: The satisfaction of patients receiving integrated care with End-Stage Renal Disease (ESRD) is widely advocated and patients with ESRD have special health needs, but few studies have investigated whether integrated care was associated with health outcomes. Our aims were to evaluate the psychometric properties of the Korean-translated patient assessment of chronic illness care (PACIC) in patients with ESRD, and to evaluate whether PACIC evaluated by patients was associated with health outcomes. Methods: ESRD patients on hemodialysis (n = 172) at 2 dialysis centers. Data quality, internal consistency and correlation between items and scales were assessed. To test the external validity, the association between PACIC and the health behaviour and outcomes of hemodialysis patients was analyzed. Results: The mean score of the PACIC items was 3.0. The item-scale correlation (0.67–0.85) and test-retest correlation (0.72–0.82) regarding scales for internal consistency showed excellent consistency. Total PACIC score was significantly associated with dietary self-efficacy (β = 0.22) and serum potassium (Exp(B) = 1.65). Higher overall PACIC score was significantly associated with higher physical health status (β = 3.52). Conclusions: The Korean-translated PACIC questionnaire is a tool with reliability and validity. Comprehensive treatment strategies for ESRD patients may improve their health behaviors and outcomes.

Improving Management of Non-communicable Chronic Diseases in Primary Healthcare Centres in The Saudi Health Care System

Evaluation of patient perceptions of quality and adequacy of care is a critical component of continuous improvement in chronic disease care. The purpose of this study was to ascertain how patients with non-communicable diseases (NCDs) assess their routine care in primary care centres in Saudi Arabia and to identify areas for improvement. This cross-sectional study used the PACIC questionnaire to assess the quality of care received by these patients in primary care centres in Saudi Arabia. Data collection took place between May 2019 and July 2019. The questionnaire was self-completed anonymously by 315 patients with NCD attending primary health care centres in Riyadh, Saudi Arabia. The results showed that the average overall PACIC score was 2.97 (SD = 0.65), the mean scores for the subscales ranged from 2.76 (SD = 0.78) for the subscale of goal settings/tailoring to 3.17 (SD = 0.78) for delivery system design/decision support. PACIC scores varied significantly with age, occupation, monthly income, type and duration of chronic illness and educational attainment. In conclusion, patients with NCDs prioritised improvements in organised care that; is comprehensive, focussed on their needs, helps them identify clear goals for their treatments and become more involved in their condition(s) management.

Development of a nursing assessment form for patients with diabetes mellitus in a hospital: A research and development study

Background

People with Diabetes Mellitus (DM) tend to seek herbal medicine or complementary drugs in their treatments. But, unfortunately, the existing nursing assessment forms have not prepared the format for the use of complementary medicine.

Objective

This study aimed to develop a nursing assessment form in patients with DM based on the Chronic Care Model (CCM) approach.

Methods

This study employed a Research and Development study design, which consists of ten stages. The nursing assessment form was developed based on CCM theory and integrated complementary medicines into the assessment form. A content validity test was done by four experts and calculated using Aiken's V formula. Face validity among 12 nurses through Focus Group Discussions (FGDs) was also employed to test the quality of the nursing assessment form based on three aspects: functionality, efficiency, and usability. In addition, nine nurses were included for pilot testing of the form. Data were analyzed using descriptive analysis.

Results

The nursing assessment form demonstrated a good content validity, with Aiken's V value of 0.94. The form was categorized based on four components of CCM: self-management support, decision support, social activities, and clinical information. Additionally, all nurses could fill the form properly.

Conclusion

The nursing assessment form is valid. It can be used for nurses to assess patients with DM based on the CCM with an additional component to evaluate the use of complementary medicine.

Psychometric evaluation of patient assessment of chronic illness care among Korean cancer survivors

Background

The Patient Assessment of Chronic Illness Care (PACIC) was developed in the United States to assess the implementation of the Chronic Care Model (CCM)-based intervention from the patient’s perspective. Although the psychometric properties of the PACIC have been reported in other chronically ill patients, it has not been reported in cancer survivors. Our aim was to evaluate the acceptability, validity, and reliability of a Korean version of the PACIC among cancer survivors (K-PACIC-CS).

Methods

Among 204 cancer survivors at a university-based hospital in South Korea, we performed psychometric evaluation of the K-PACIC-CS according to acceptability (descriptive statistics, missing values, and floor and ceiling effects), validity (confirmative factor analysis [CFA] and convergent validity), and reliability (internal consistency, i.e., Cronbach’s alpha).

Results

The item response was high (missing rate = 0.5%). The floor effect was 3.9%– 43.6% and the ceiling effect was 6.9%– 41.2%. The CFA revealed good indices of fit and confirmed the five structures predetermined in the original version of PACIC. The K-PACIC-CS scores had significant positive relationships with cancer survivors’ self-efficacy and health-related quality of life. The total K-PACIC-CS showed excellent internal consistency (Cronbach’s alpha = .94) and those of the subscales were acceptable (Cronbach’s alpha = .76 -.86).

Conclusions

This study suggests that the K-PACIC-CS is a valid and reliable instrument for measuring implementation of CCM-based chronic care from the survivor’s perspective.

Perceived quality of care among people with type 2 diabetes mellitus in the north east region of peninsular Malaysia

BACKGROUND

People with type 2 diabetes mellitus (T2DM) are best managed by a chronic care model that is associated with enhanced quality of care and improved patient outcome. Assessing patients' perceived quality of care is crucial in improving the healthcare delivery system. Hence, this study determined the perceived quality of care among people with T2DM and explored its associations with (i) sociodemographic and clinical characteristics and (ii) types of healthcare clinics to guide future planning.

METHODS

A cross-sectional study involving 20 primary healthcare clinics in the North East Region of Peninsular Malaysia and people with T2DM as the sampling unit was conducted from February to May 2019. The pro forma checklist, interview-guided Skala Kepuasan Interaksi Perubatan-11, and Patient Assessment of Chronic Illness Care (Malay version; PACIC-M) questionnaire were used for data collection. Univariate analysis and linear regression were used to determine the status of perceived quality of care and the factors associated with the perceived quality of care, respectively.

RESULTS

Overall, data from 772 participants were analyzed. The majority was from the Malay ethnic group (95.6%) with a mean (standard deviation [SD]) glycated hemoglobin A1c (HbA1c) level of 8.91% (2.30). The median (interquartile range [IQR]) of the number of medical officers available at each clinic was 6 (7), with Family Doctor Concept (FDC) clinics having a higher number of medical officers than non-FDC clinics (p = 0.001). The overall mean (SD) PACIC-M score was 2.65 (0.54) with no significant difference between scores of patients treated in the two clinic types (p = 0.806). Higher perceived quality of care was associated with lower number of medical officers (adjusted regression coefficient [Adj.β], - 0.021; p-value [p], 0.001), and greater doctor-patient interaction in all domains: distress relief (Adj.β, 0.033; p, < 0.001), rapport (Adj.β, 0.056; p, < 0.001), and interaction outcome (Adj.β, 0.022; p, 0.003).

CONCLUSION

Although there was no significant difference found between clinic type, this study reflects that patients are comfortable when managed by the same doctor, which may support a better doctor-patient interaction. A larger specialized primary care workforce could improve diabetes care in Malaysia.

Using confirmatory factor analysis and Rasch analysis to examine the dimensionality of The Patient Assessment of Care for Chronic Illness Care (PACIC)

PURPOSE

The PACIC assesses key components of the Chronic Care Model. The purpose of this study is to examine the dimensionality and psychometric properties of the PACIC.

METHODS

A convenience sample of 221 adults in Canada who self-identified as living with one or more physical and/or mental chronic diseases was invited to participate via an online survey link. Rasch analysis was performed, including item and person misfit, reliability, response format, targeting, unidimensionality of subscales, and differential item functioning (DIF). Also, Confirmatory Factor Analysis (CFA) was conducted and model fit of alternative factor structures proposed for the PACIC in the literature and those suggested by the Rasch analysis were explored.

RESULTS

The patient activation, delivery system, and problem-solving subscales fit the Rasch model expectations; no modifications were required. The goal setting item 10 had a disordered threshold and was recoded. Four of the five follow-up subscale items had a disordered threshold and were recoded. All subscales were unidimensional and no local dependency was detected. DIF was only detected for some items in the follow-up subscale. The CFA revealed that none of the published factor structures fit the data; the fit statistics were appropriate when item 10 was removed and the follow-up subscale was removed.

CONCLUSIONS

Improving chronic disease care relies upon having validated measures to evaluate the extent to which care goals are met. With some modifications, four of the five PACIC subscales were found to be psychometrically robust.

Reliability and validity of the Greek translation of the patient assessment of chronic illness care + (PACIC-PLUS GR) survey

Background

This study aimed to investigate the Patient Assessment of Chronic Illness Care+ (PACIC+) which is a tool to assess care for Chronic Conditions combining PACIC items with an overall 5As score derived from the ‘5As’ model (ask, advise, agree, assist, and arrange), and is congruent with the Chronic Care Model. In addition, the study at hand aimed to translate the PACIC+ tool into Greek and test its psychometric properties to the Greek patients.

Methods

Questionnaires were collected from 268 chronic patients. Internal consistency and reliability were determined by the calculation of Cronbach’s alpha coefficient. A confirmatory factor analysis (CFA) was conducted in order to test the construct validity of the questionnaire. Validity was further examined by investigating the correlation of PACIC+ with SF-36 and its association with sex and age.

Results

Internal consistency reliability was accepted with a Cronbach’s alpha above 0.70 for all PACIC+ dimensions. CFA showed that the 10-dimensional model fitted the data well (RMSEA = 0.059, CFI = 0.91 and GFI = 0.83). Most of the correlations coefficients between PACIC+ and SF-36 dimensions were significant. A significant and negative correlation was found between PACIC+ summary score, Patients’ activation and Goal Setting/ Tailoring with age.

Conclusions

The Greek translation of the PACIC+ questionnaire has good psychometric properties and has proven to be a credible and valid tool to be used by Greek researchers in order to measure patients’ perceived care during treatment. It demonstrated high reliability and internal consistency, extending the applicability of this instrument to Greek speaking chronic patients.

Effectiveness and cost-effectiveness of the Assessment of Burden of Chronic Conditions (ABCC) tool in patients with COPD, asthma, diabetes mellitus type 2 and heart failure: protocol for a pragmatic clustered quasi-experimental study

INTRODUCTION

The number of people that have one or multiple condition(s) with a chronic course is rising, which consequently challenges healthcare systems. Healthcare geared to long-term care should focus on patient-centredness, shared decision making and self-management. The Assessment of Burden of Chronic Conditions (ABCC) tool was developed to integrate these elements in daily healthcare practice. The ABCC tool assesses and visualises burden of disease(s), helps to make shared decisions and stimulates self-management. The present paper documents a protocol for a quasi-experimental study investigating the effectiveness and cost-effectiveness of the ABCC tool for people with chronic obstructive pulmonary disease, asthma, type 2 diabetes mellitus and/or heart failure.

METHODS AND ANALYSIS

The study has a pragmatic clustered quasi-experimental design and will be conducted in the Netherlands. The intervention will be allocated at the level of general practice. The intervention group (18 general practices, 180 patients) will use the ABCC tool during regular consultations; the control group (18 general practices, 180 patients) will maintain usual care. Outcomes include change in quality of care (Patient Assessment of Chronic Illness Care), quality of life (EuroQol-5D-5L), capability well-being (ICEpop CAPability measure for Adults), patients' activation (Patient Activation Measure) and costs. Follow-up time will be 18 months. Outcomes will be analysed using linear mixed models.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Medical Ethics Committee Zuyderland-Zuyd Heerlen, the Netherlands (METCZ20180131). Results will be published in peer-reviewed journals and will be presented at national and international conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04127383).

Higher patient assessed quality of chronic care is associated with lower diabetes distress among adults with early-onset type 2 diabetes: Cross-sectional survey results from the Danish DD2-study

AIM

Among adults aged 20-45 years with type 2 diabetes mellitus, we examined the perceived quality of chronic care, and its associations with (i) sociodemographic and clinical characteristics, and (ii) diabetes distress.

METHODS

In total, 216/460 (47%) completed a self-administered survey assessing sociodemographic characteristics, patient assessed chronic illness care (PACIC-20, scale of 1-5) and diabetes distress (PAID-20, scale of 0-100), and 197 had full quality of care data for assessment. We obtained clinical data from national registers and used linear and logistic regression models to examine associations.

RESULTS

The mean (SD) PACIC score was 2.6 (0.9) (score range 1-5). Lower PACIC scores were associated with female sex and current unemployment, and with receiving diabetes care in general practice compared with hospital outpatient clinics [mean difference: -0.4 (95% confidence interval (CI) (-0.7 to -0.2)]. People with upper quartile PACIC scores were less likely to report high diabetes distress compared with people with lower quartile PACIC scores [odds Ratio 0.3 95%CI (0.1-0.8)].

CONCLUSION

Higher quality of care was associated with lower diabetes distress among adults with early onset type 2 diabetes mellitus, but respondents reported less than optimal quality in several core areas of chronic care.

Autoeficacia y satisfacción de los usuarios con diabetes tipo 2 de un centro de salud chileno

Introducción: La diabetes mellitus es un problema de salud pública que ocasiona afecciones biopsicosociales en los individuos que la padecen, conllevando a la necesidad de valorar aspectos que pueden incidir en su compensación tal como la autoeficacia y la satisfacción usuaria. Materiales y métodos: Se desarrolló una investigación cuantitativa de tipo correlacional que tuvo como referente el Modelo de Promoción de la Salud, y que incluyó  por muestreo aleatorio simple a 86 individuos con diabetes mellitus tipo 2, en quienes se pudo establecer su perfil, percepción de autoeficacia y satisfacción usuaria  a través del instrumento para la evaluación de autoeficacia en Diabetes tipo 2 (alfa de Cronbach de 0,85) y el PACIC(Patient Assessment of Chronic Illness Care) (alfa de Cronbach de 0,88). Resultados: Los usuarios en su mayoría son mujeres (65%), en etapa de adulto medio (65,1%), se perciben como autoeficaces(82,6%) y muestran satisfacción por el servicio ofrecido(76,7%), presentando descompensación metabólica (57%). Se pudo apreciar asociación entre la autoeficacia y el grupo etario (p=0,002), contar con pareja (p=0,029), la hemoglobina glicosilada (p=0,007) y el estado cognitivo de los adultos mayores (p=0,017), al igual que entre la satisfacción y el grupo etario (p=0,033), el sexo (<0,001), y la situación laboral (p=0,005). Discusión: El perfil establecido coincide con el reportado en otras publicaciones. La autoeficacia y satisfacción usuaria son aspectos que se relacionan con la compensación de los usuarios. Conclusiones: Se requiere potenciar aspectos como la autoeficacia y la satisfacción usuaria,  siendo pertinente la aplicación del Modelo de Promoción de la Salud. Como citar este artículo: Fernández-Silva Carlos Alberto, Antiñirre Mansilla Betty, De La Hoz Chávez Viviana Carolina. Autoeficacia y satisfacción de los usuarios con diabetes tipo 2 de un centro de salud chileno. Revista Cuidarte. 2020; 11(2): e933. http://dx.doi.org/10.15649/cuidarte.933

[Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors]

PURPOSE

This study aimed to examine the levels of perceived self-management support, self-efficacy for self-management, and health-related quality of life (HRQoL) in cancer survivors, and to identify the mediating effect of self-efficacy in the relationship between perceived self-management support and HRQoL.

METHODS

This study used a descriptive correlational design. Two hundred and four cancer survivors who had completed treatment participated in the study. Measurements included the Patient Assessment of Chronic Illness Care Scale, the Korean version of the Cancer Survivors' Self-Efficacy Scale, and the Medical Outcomes Study Short Form-36. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and multiple regression analysis using Baron and Kenny's method for mediation.

RESULTS

The mean score for perceived self-management support was 3.35 out of 5 points, self-efficacy was 7.26 out of 10 points, and HRQoL was 65.90 out of 100 points. Perceived self-management support was significantly positively correlated with self-efficacy (r=.29, p<.001) and HRQoL (r=.27, p<.001). Self-efficacy was also significantly correlated with HRQoL (r=.59, p<.001). Furthermore, self-efficacy (β=.55, p<.001) had a complete mediating effect on the relationship between perceived self-management support and HRQoL (Z=3.88, p<.001).

CONCLUSION

The impact of perceived self-management support on HRQoL in cancer survivors was mediated by self-efficacy for self-management. This suggests that strategies for enhancing self-efficacy in cancer survivors should be considered when developing self-management interventions for improving their HRQoL.

Psychometric properties of the Patient Assessment of Chronic Illness Care measure (PACIC-5A) among patients with obesity

Background

The Patient Assessment of Chronic Illness Care (PACIC-5A) was developed to assess the satisfaction with patient-provider interaction based on the Chronic Care Model. The additional 5A approach (assess, advise, agree, assist, arrange) allows to score behavioral counseling. The aim of the study was to assess the psychometric properties of the German adaptation of the PACIC-5A questionnaire in a sample of general practitioners (GP) patients with obesity.

Methods

Analyses were based on data from the study “Five A’s counseling in weight management of obese patients in primary care: a cluster randomized controlled trial (INTERACT)”. Data were collected via standardized questionnaires containing the 26-item version of the PACIC-5A questionnaire. A total of 117 patients with obesity were included in the analyses. Statistical procedures comprised descriptive analyses, the calculation of Cronbach’s alpha, test-retest analyses and factor analyses in order to assess the psychometric properties including reliability and validity of the PACIC-5A.

Results

The patient’s mean age was 43.4 years and the sample was mostly female (59%). Middle educational level was found for the majority (78%) and the mean Body Mass Index was 38.9 kg/m². Descriptive analyses revealed a mean PACIC score of 2.33 and 5A sum score of 2.29. Notable floor effects were found. PACIC-5A showed high level of internal consistency (Cronbach’s alphas > 0.9) and exploratory factor analyses resulted in a unidimensional structure.

Conclusion

The results of this study provide evidence regarding the psychometric properties of the German version of the PACIC-5A used in a sample of GP patients with obesity and make an important contribution to the reliable and valid assessment of the patient-GP interaction with regard to obesity counseling in primary care.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3871-1) contains supplementary material, which is available to authorized users.

Patients' assessment of chronic illness care: a validation study among patients with type 2 diabetes in Finland

BACKGROUND

To meet the challenges of the rising prevalence of chronic diseases, such as type 2 diabetes, new approaches to healthcare delivery have been initiated; among these the influential Chronic Care Model (CCM). Valid instruments are needed to evaluate the public health impact of these frameworks in different countries. The Patient Assessment of Chronic Illness Care (PACIC) is a 20-item quality of care measure that, from the perspective of the patient, measures the extent to which care is congruent with the CCM. The aim of this study was to evaluate the psychometric properties of the Finnish translation of the PACIC questionnaire, in terms of validity and reliability, in a large register-based sample of patients with type 2 diabetes.

METHOD

The PACIC items were translated into Finnish in a standardized forward-backward procedure, followed by a cross-sectional survey among patients with type 2 diabetes (response rate 56%; n = 2866). We assessed the Finnish version of the PACIC scale for the following psychometric properties: content validity, internal consistency reliability, convergent and construct validity. We also present descriptive data on total scale as well as predetermined subscale levels.

RESULTS

The item-response on the PACIC scale was high with only small numbers of missing data (0.5-1.1%). Ceiling effects were low (0.3-5.3%) whereas floor effects were over 20% for two of the predetermined subscales (problem solving and follow-up/coordination). The total PACIC scale showed a reasonable distribution and excellent internal consistency (alpha 0.94) while the internal consistency of the subscales were at least acceptable (0.74-0.86). The principal component analysis identified a two- or three-factor solution instead of the proposed five-dimensional. In other respects, the PACIC scale showed the hypothesized relationships with quality of care and outcome measures, thus demonstrating convergent and construct validity.

CONCLUSION

A Finnish version of the PACIC scale is now validated in the primary care setting among patients with type 2 diabetes. The findings suggest comparable psychometric properties of the Finnish scale as of the original English instrument and earlier translations, and reasonable levels of validity and reliability.

Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument

RATIONALE, AIMS AND OBJECTIVE

Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments.

METHODS

Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC.

RESULTS

Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs.

CONCLUSION

Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.

Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study

BACKGROUND

Previous research using cross-sectional data has shown a positive relationship between patient activation and quality of care. The quantitative relationships in the same patients over time, however, remain undefined.

OBJECTIVE

To examine the relationship between changes in activation over time and patient-assessed quality of chronic illness care.

DESIGN

Prospective cohort study.

PARTICIPANTS

The study used data reported annually from 2008 (N = 3761) to 2010 (N = 3040), using self-report survey questionnaires, completed by patients with type 2 diabetes in a population-based cohort in Queensland, Australia.

MAIN MEASURES

Principal measures were the 13-item Patient Activation Measure (PAM), and the 20-item Patient Assessment of Chronic Illness Care (PACIC) instrument.

METHODS

Nonparametric anova was used to determine the association between patient activation and patient-assessed quality of care in low and high patient activation groups at baseline (2008), and in 2009 and 2010, when patients had changed group membership. The Wilcoxon signed ranks test was used to compare the PACIC scores between baseline and each follow-up survey for the same patient activation level.

RESULTS

Patient activation was positively associated with the median PACIC score within each survey year and within each of the groups defined at baseline (high- and low-activation groups; P < 0.001).

CONCLUSIONS

Patient activation and the PACIC change in the same direction and should be considered together in the interpretation of patient care assessment. This can be carried out by interpreting PACIC scores within strata of PAM.