Quality issues of self-report of hypertension: analysis of a population representative sample of older adults in Taiwan

Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore

Introduction: Studies of concordance between patients’ self-report of diseases and a criterion standard (e.g. chart review) are usually conducted in epidemiological studies to evaluate the agreement of self-reported data for use in public health research. To our knowledge, there are no published studies on concordance for highly prevalent chronic diseases such as diabetes and pre-diabetes. The aims of this study were to evaluate the concordance between patients’ self-report and their medical records of diabetes and pre-diabetes diagnoses, and to identify factors associated with diabetes concordance. Method: A cross-sectional, interviewer-administered survey was conducted on patients with chronic diseases after obtaining written consent to assess their medical notes. Interviewers were blinded to the participants’ profiles. Concordance was evaluated using Cohen’s kappa (κ). A multivariable logistic regression model was used to identify factors associated with diabetes concordance. Results: There was substantial agreement between self-reported and medical records of diabetes diagnoses (κ=0.76) and fair agreement for pre-diabetes diagnoses (κ=0.36). The logistic regression model suggested that non-Chinese patients had higher odds of diabetes concordance than Chinese patients (odds ratio [OR]=4.10, 95% confidence interval [CI] 1.19–14.13, P=0.03). Patients with 3 or more chronic diseases (i.e. multimorbidity) had lower odds of diabetes concordance than patients without multimorbidity (OR=0.21, 95% CI 0.09–0.48, P<0.001). Conclusion: Diabetes concordance was substantial, supporting the use of self-report of diabetes by patients with chronic diseases in the primary care setting for future research. Pre-diabetes concordance was fair and may have important clinical implications. Further studies to explore and improve health literacy and patient-physician communication are needed. Keywords: Concordance, diabetes, multimorbidity, primary care, self-reported data

Validity of self-reported hypertension in India: Evidence from nationally representative survey of adult population over 45 years

Self‐reported measures of health, in the context of developed countries, are well‐researched and commonly regarded as reliable predictors of the underlying health of the population. However, the validity of these measures is under‐researched and questionable in the context of low‐ and middle‐income countries. The authors used Longitudinal Ageing Study in India (LASI) survey data from India to compare self‐reported hypertension with biometrically‐measured hypertension. The results are reported in terms of sensitivity, specificity, and kappa as a measure of agreement. Logistic regression was undertaken to examine the characteristics of those who were unaware of their hypertensive status. Our analysis showed a low sensitivity of 56% and a high specificity of 90.5%. Agreement between self‐reported data and biometric measurement of hypertension was observed to be moderate (κ = 0.48). Large variations were observed among states and sub‐groups. The odds of false negative reporting of hypertension were lower in the individuals with higher age, high education, and greater wealth status. The authors conclude that self‐reported hypertension has important limitations and may be a source of systematic bias. It is recommended that planning and policy‐making in India be based more on an objective assessment of hypertension.

Accuracy of Self-Reported Hypertension, Diabetes, and Hyperlipidemia among Adults of Liwan, Guangzhou, China

Background:

We aimed to determine the accuracy of self-reported diabetes, hypertension, and hyperlipidemia in Chinese adults and examine factors that affect the accuracy of self-reports.

Methods:

This representative cross-sectional survey was conducted in Liwan District, Guangzhou City, Southeast China. Self-reported data were collected using a structured questionnaire. Biometrical data were recorded, including blood lipid, blood glucose and arterial blood pressure levels. Sensitivity, specificity, and κ values of self-reports were used as measurements of accuracy or agreements. The Robust Poisson-GEE was applied to determine the association of participants’ characteristics with the accuracy of self-reports.

Results:

Self-reported and biometrical data of 1278 residents aged 18 yr and older (693 women and 585 men) were used to calculate three measures of agreement. The agreement between self-reports and biomedical measurements was substantial for both hypertension and diabetes (κ=0.77 and 0.76), but only slight for hyperlipidemia (κ=0.06). Similarly, the sensitivity was higher for hypertension and diabetes (72.3% and 71.2%) than for hyperlipidemia (6.8%), while the specificity was high overall (≥98%). The factors associated with an accurate self-reported diagnosis in respondents with disease included having undergone blood pressure measurement (for hypertension) or blood glucose measurement (for diabetes) in the past 6 month, having attended health knowledge lectures in the past year and having social health insurances (for hypertension), and having undergone physical discomfort in the past 2 weeks (for hypertension and diabetes).

Conclusion:

The accuracy of self-reported hypertension and diabetes was high, whereas that of self-reported hyperlipidemia was lower among the population.

Assessment of patient experience profiles and satisfaction with expectations of treatment effects by using latent class analysis based on a national patient experience survey in Taiwan

OBJECTIVES

Health system responsiveness is a complicated issue that guides researchers wishing to design an efficient methodology for enhancing understanding of perspectives regarding healthcare systems. This study examined the relationship between patient experience profiles and satisfaction with expectations of treatment effects.

DESIGN

This was a cross-sectional study. We used eight items obtained from latent class analysis to develop patient experience profiles.

SETTING

Primary care users in Taiwan.

PARTICIPANTS

This study conducted an annual National Health Insurance survey in Taiwan and sampled from those who had experience with the medical service in primary care clinics in 2015.

PRIMARY OUTCOME MEASURE

Respondents were asked to indicate the extent of their satisfaction with their expectation of treatment effects (or symptom improvement).

RESULTS

The proportions of participants in groups 1-4 were 34%, 24%, 29% and 12%, respectively. Patients in good health were more satisfied with their expectations of treatment effects (OR 1.639, p=0.007). Furthermore, group 4 (-eAll) were less satisfied with their expectations of treatment effects than those in the other three groups (ORs: group 1 (+eAll): 9.81, group 2 (-CwR): 4.14 and group 3 (-CnR): 4.20).

CONCLUSIONS

The results revealed that experiences of poor accessibility and physician-patient relationships affected the patients' expectations. Therefore, greater accessibility and more positive physician-patient relationships could lead to higher patient satisfaction with their expectations of treatment effects. Furthermore, the findings could assist authorities in targeting specific patients, with the objective of improving their healthcare service experience. They could also serve as a mechanism for improving the quality of healthcare services and increase accountability in healthcare practices.