Measuring Primary Care Across 35 OECD Countries

Usual source and better quality of primary care are associated with lower loneliness scores: a cross-sectional study

BACKGROUND

Loneliness is a global issue, and primary care physicians play an important role in assessing and intervening with loneliness. This study aimed to examine the association between having a usual source of care (USC) or a good quality of primary care, and loneliness.

METHODS

This cross-sectional study was conducted in Japan in 2022. A total of 6,000 residents were randomly sampled from the general population, aged 20-74 years. The outcome was the total score of the University of California, Los Angeles (UCLA) 3-item loneliness scale. The exposure included USC and the Person-Centered Primary Care Measure (PCPCM), which assesses the quality of primary care. We conducted a linear regression analysis to adjust for age, sex, educational status, annual household income, self-rated health, living status (whether alone or not), and the existence of physical health problems.

RESULTS

Of the 6,000 residents, 1,277 responded to the survey. The median score of the UCLA 3-item loneliness scale was 6.0 and the mean total score of the PCPCM was 2.62. Of the 1,277 individuals, 713 (55.8%) had USC. Having USC was significantly associated with lower scores on the UCLA 3-item loneliness scale; the coefficient was -0.34 (95% confidence interval (CI): -0.57 to -0.12). Also, the total PCPCM score was significantly associated with lower loneliness scores; the coefficient was -0.56 (P < 0.001, 95% CI: -0.78 to -0.35).

CONCLUSIONS

Having USC and a better quality primary care were associated with a lower loneliness score. The quality of primary care could be a factor to mitigate patient loneliness.

Patient experiences in primary care do not differ according to rurality: a cross-sectional study

BACKGROUND

Living in rural areas is a major contributor of health inequity. Tackling health inequity is important for primary care physicians. Therefore, it is important to compare the quality of primary care between rural and urban areas. To the best of our knowledge, this is the first study to examine the association between rurality and patient experience (PX) in Japan using validated measures.

METHODS

This cross-sectional study was conducted using online surveys. Participants were selected using a stratified random sample based on sex and age. The Japanese version of the Person-Centered Primary Care Measure (PCPCM) was used as an indicator of PX. We used the Rurality Index for Japan (RIJ) to measure rurality. Furthermore, we used multivariate linear regression analysis to examine the relationship between the RIJ and PCPCM after adjusting for confounders.

RESULTS

Of the 1112 eligible participants, 800 responded to the survey (response rate:71.9%). The mean PCPCM scores were 2.46 (standard deviation: 0.73) and median RIJ was 15 (interquartile range: 6-33). The crude and adjusted coefficients of rurality were - 0.02 (- 0.006-0.001, p = 0.114) and - 0.02 (- 0.005-0.001), respectively, demonstrating that rurality was not significantly associated with the total PCPCM score. Subgroup analyses were similar to the main analyses.

CONCLUSION

We found that PX in primary care did not differ by rurality in the general Japanese population.

Social Needs Screening and Intervention in Pediatric Primary Care: Impact on Families' Experience of Care

INTRODUCTION/OBJECTIVES

Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention.

METHODS

We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM).

RESULTS

Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = -0.04, 95%CI -0.16, 0.09, P = .58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services.

CONCLUSIONS

Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice.

The Role of Primary Care in Improving Population Health

Policy Points Systems based on primary care have better population health, health equity, and health care quality, and lower health care expenditure. Primary care can be a boundary-spanning force to integrate and personalize the many factors from which population health emerges. Equitably advancing population health requires understanding and supporting the complexly interacting mechanisms by which primary care influences health, equity, and health costs.

Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study

The integration of chronic disease management (CDM) services into the essential public health services offered by primary care facilities has been a major strategy in China's healthcare reform since 2009. We aimed to measure the percentage of patients with chronic diseases in China who believed that they could easily obtain CDM services at a nearby primary care facility in mainland China and determine its association with the EQ visual analog scale (EQ-VAS) score and the utility index of the 5-level EQ-5D version (EQ-5D-5L). A cross-sectional survey was conducted nationwide between 20 June 2022 and 31 August 2022, involving 5525 patients with chronic diseases from 32 provincial-level administrative divisions, of which 48.1% (n = 2659) were female with a median age of 55.0 years. The median EQ-VAS score was 73.0 and the utility index of the EQ-5D-5L was 0.942. A majority of patients reported definite (24.3%) or mostly (45.9%) easy access to CDM services from nearby primary care facilities. Multivariable logistic regression analysis revealed that easy access to CDM services in primary care facilities was positively associated with higher HRQoL. Our findings indicate that, as of 2022, approximately 70% of patients with chronic diseases in mainland China had easy access to CDM services provided by primary care facilities, which was significantly and positively associated with their health status.

Development and validation of a Japanese version of the person-centered primary care measure

Background

Although primary care (PC) is an indispensable part of the health system, measuring its quality is challenging. A recent measure of PC, Person-Centered Primary Care Measure (PCPCM), covers 11 important domains of PC and has been translated into 28 languages. This study aimed to develop a Japanese version of the PCPCM and assess its reliability and validity.

Methods

We employed a cross-sectional mail survey to examine the reliability and content, structure, criterion-related, and convergent validity of the Japanese version of the PCPCM. This study targeted 1000 potential participants aged 20–74 years, selected by simple random sampling in an urban area in Japan. We examined internal consistency, confirmatory factor analysis, correlation between the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF), and the association between the PCPCM score and influenza vaccine uptake.

Results

A total of 417 individuals responded to the survey (response rate = 41.7%), and we used the data of 244 participants who had the usual source of care to assess the reliability and validity of the PCPCM. Confirmatory factor analysis demonstrated sufficient structural validity of the original one-factor structure. The overall Cronbach’s alpha was 0.94. The Spearman correlation coefficient between PCPCM and JPCAT-SF was 0.60. Influenza vaccine uptake was not significantly associated with total PCPCM score.

Conclusions

The study showed that the Japanese version of the PCPCM has sufficient internal consistency reliability and structural- and criterion-related validity. The measure can be used to compare the quality of primary care in Japan and other countries.

Patient experiences with general practitioners: psychometric performance of the generic PEQ-GP instrument among patients with chronic conditions

BACKGROUND

Most generic patient experience instruments have not been validated specifically for persons with chronic health problems, even though they are the dominant user of GPs/family physicians.

OBJECTIVES

To assess the psychometric properties of the generic Patient Experiences with GP Questionnaire (PEQ-GP) instrument (five scales: assessment of GP, coordination, patient enablement, accessibility, and practice) in persons with chronic conditions, and to develop a short version to maximize response rates and minimize respondent fatigue in future applications.

METHODS

Secondary analysis of data from a national survey of patient experiences with general practitioners in 2018-2019 (response rate: 42.6%). The psychometric properties of PEQ-GP were assessed with exploratory factor analysis and Cronbach's alpha, supplemented with confirmatory factor analysis (CFA) and item response theory (IRT). A short version was constructed and evaluated based on item performance.

RESULTS

Nine hundred and seventy persons reported a chronic condition(s), the most frequent being "musculoskeletal, arthritis, other back and joints" (n = 473, 48.8%). Factor analysis identified three scales with adequate psychometric results: GP (15 items; Cronbach's alpha: 0.96), practice (3 items; Cronbach's alpha: 0.87), and accessibility (2 items; Cronbach's alpha: 0.77). Evaluation of item performance identified a 7-item short version, including a 5-item GP scale with scores with strong concordance with the 15-item scale (Intraclass Correlation Coefficient: 0.97, P < 0.001).

CONCLUSIONS

The generic PEQ-GP exhibits adequate psychometric performance for persons with chronic conditions. Three empirically derived PEQ-GP scales cover evaluation of the GP, accessibility, and practice. The 7-item short form minimize respondent burden, but further validation work is warranted before large-scale use.