Background
Author1
| Country | Mean scores (& | Acceptability | Structure | Associations with: | Associations with: | |
---|---|---|---|---|---|---|---|
PACIC version | N (Response rate) | Cronbach’s alpha) | ·health conditions | ·other measures | |||
Context | a. PACIC; b. PA; | ·other measures of | ·patient characteristics | ||||
c. DS/PD; d. GS/T; e. PS/C; f. F/C (other reliability data) | chronic care | ·interventions | |||||
Aragones [15] | USA | a.3.17 (0.87) | Reports no ceiling or floor effects | Type of analysis not clear | No significant association with number of chronic conditions | No significant association with age, sex, education, insurance, years in the US | |
Spanish language version | Sample 1: 100/120 (83%) | b. – f. 2.50 – 3.95 (all >0.6) | Factor loading analysis – most items correlated highly on proposed scales | ||||
Sample 2: 20 telephone interview follow ups | |||||||
Spanish speaking Hispanics with diabetes in hospital ambulatory settings | (Test Re-test 0.77) | ||||||
Carryer [16] | New Zealand | GP care/Nurse care | Professional self ratings much higher (on modified version of PACIC): | ||||
Modified PACIC for professionals | Sample 1: 341 (85.3% - of those who expressed an interest in participating) | a.2.7/3.3 | a.4.0 | ||||
b.2.9/3.5 | b.4.3 | ||||||
c.3.1/3.7 | c.3.8 | ||||||
d.2.3/3.2 | d.3.8 | ||||||
Sample 2: 89 GPs & nurses | e.2.8/3.5 | e.4.1 | |||||
Primary care patients and practitioners | f.2.6/2.9 | f.3.8 | |||||
Gensichen [8] | Germany | a.3.25 (0.91) | Ceiling effects: PA (12.9%) and PS/C (8.9%) | EFA two factors (‘Patient activation | Overall PACIC with number of conditions and PHQ9 both NS | No significant associations with age, sex, education | |
German language version | 442/485 (91.1%) | b.3.65 (0.80) | Floor effects: | and problem solving’ and ‘ Goal setting and co-ordination’) 46.5% | High correlations with all EUROPEP scales | ||
Patients with major depression in primary care | c.3.47 (0.45) | GS/T (4.6%) | |||||
d.2.97 (0.74) | Missing data from 0.7% - 5.4% | some items did not load as expected | |||||
e.3.69 (0.77) | |||||||
f.2.83 (0.76) | |||||||
Glasgow [7] | USA | a.2.60 (0.93) | No items had ceiling effects | CFA – moderate fit | No variation in response across 6 most common long- term conditions (excluding diabetes patients who report better follow up); Higher PACIC scores associated with more conditions (r = 0.13, p<0.05) | Correlations (PACIC and subscales) with patient characteristics all <=0.25; Higher overall PACIC related to age (higher) and gender (female); Gender significantly related to all subscales (0.14 to 0.25; P<0.05) | |
Sample 1: 379/500 (76%) of which 283 had chronic condition (57%) | b.2.99 (0.82) | Floor effects identified, but not reported in detail | |||||
c.3.13 (0.77) | 96% had no missing data | ||||||
d.2.43 (0.84) | |||||||
e.2.87 (0.90) | |||||||
Sample 2: 82/100 sent follow up at +12 weeks (82%) of which 63 had chronic condition (63%) | f.1.07 (0.86) | ||||||
Primary care | (3 month re-test 0.58) | Overall PACIC and all subscales correlate significantly with Hibbard Activation and Safran Assessment of primary Care sub scales (with exception of PACIC F/C and Safran Integration sub scale) | |||||
Glasgow [12] | USA | a.3.2 (0.96) | Adequate variability | No significant relationship to number of conditions | Correlated with physical activity (r=0.17) but not fat consumption | ||
Includes PACIC 5As | 363 (63%) | b.3.6 | 3-9% sub scale scores <1.5, (4% on summary scale) | Related to quality of care (composite lab assessment r=0.23) and composite self management support (r=0.25) | No significant differences with sex, ethnicity or income | ||
Type 2 diabetes patients in primary care | c.3.5 | 7-22% sub scale scores >4.5 (9% on summary scale) | |||||
d.3.0 | |||||||
e.2.9 | |||||||
f.3.4 | |||||||
5As mean = 3.2 | |||||||
Goetz [17] | Germany | Patients tended to gravitate to both end points (0% and 100%) | FA indicated a 1 factor solution for the PACIC short form | There was no correlation between the mean overall score of the PACIC short form and number of chronic conditions | |||
PACIC short form & revised scoring | 264 (49%) | Non-response rates ranged from 4.2% - 12.5% | |||||
Over 18 with at least one chronic condition in primary care | |||||||
Gugiu [13] | US | (Short form PACIC – 11 items – Ordinal alpha = 0.955 (sample 1) and 0.963 (sample 2); Ordinal omega 0.956 (S1) & 0.963 (S2); Eight month Test re-test reliability (n=250) = 0.638) | EFA within a CFA | No associations with HBa1c, LDL, microalbumin, BP | |||
Modified PACIC percentage scale | Sample 1: 529/943 (55%) | Unidimensional, 11 item variant | |||||
Sample 2: 361/943 (38%) (111 not in first sample) | |||||||
Type 2 diabetics, large physician networks | |||||||
Gugiu [9] | USA | (Short form PACIC – 11 items, Alpha 0.945, ordinal alpha 0.972, ordinal omega 0.973) | Missing data 0.2% | CFA Poor fit to 5 factors | No associations with clinical indicators | ||
Modified PACIC percentage scale (linked to above) | 539/943 (57%) | to 2.8%, 8.9% failed to respond to at least 1 | EFA 1–3 factors, 1 factor preferred | ||||
Type 2 diabetics, large physician networks | Kurtosis (trimodal, 43% 90-100%, 24% 0-10%) | ||||||
Jackson [18] | USA | a.3.1 | Non white patients more likely to report experience consistent with the CCM (OR 2.3) (PS and FU significant among subscales); Patients not completing high school more likely to report experience consistent with the CCM (OR 3.0) and subscales | ||||
204 (69%), but 189 (64%) complete information | b.3.3 | ||||||
Patients with diabetes receiving VA primary care services | c.3.6 | ||||||
d.3.1 | |||||||
e.3.4 | |||||||
f.2.6 | |||||||
Maindal [11] | Denmark | a.(0.94) | Missing 0.5 – 2.9% | CFA good fit for 2 indices, poor for 4 | Patients with self-rated good health reported higher scores on ‘Patient Activation’, ‘Decision Support’ and ‘Goal Setting’; Patients with more than one additional disease rated lower on PA and DS | No significant associations with sex, age | |
Danish Language version | 1265/2476 but only 560 met criteria of diabetes > 2 years + medical treatment (22.6%) | b. – f. (0.71 – 0.86) | Floor effects: 2.7% - 69.2%, >15% for 17 items | ||||
Patients on national diabetes register | Ceiling effects: 4.0% – 4.04%, >15% for 12 items | ||||||
Rosemann [19] | Germany | Male/Female | Adequate variability | Education and age predicted overall PACIC score in regression | Significant relationships with disease duration, BMI, co-morbidities, PHQ sum, AIMS2F, | Significant differences by gender and educational level (p<0.01), marital status and age (p<0.05), | |
German language version | 1021/1250 (81.7%) | a.2.79/2.67 | |||||
PACIC 5As | Patients with OA in primary care practices | b.3.51/3.39 | |||||
c.3.34/3.33 | |||||||
d.2.41/2.31 | |||||||
e.2.39/2.29 | |||||||
f.2.94/2.62 | |||||||
Rosemann [20] | Germany | a.2.44 (0.90) | Adequate variability in the overall scale & all subscales | PACIC and GS/T and FU/C scores significantly higher for patients with co-morbid diabetes, but no significant associations with other co-morbidities (hypertension, depression, CHD, COPD) | Age and gender showed weak correlations with overall PACIC and majority of subscales; no significant relationship with educational level. | ||
German language version | Sample 1: 236/300 – 78.6%. | b.2.79 (0.85) | Floor effects in 3 subscales (F/C - 4.6%; PA - 3.8%; and GS/T - 3.4%). | Strong correlations found between PACIC sub scales and EUROPEP as expected | |||
PACIC 5As | Sample 2: 71 of subset of 75 sent follow up questionnaire after 2 weeks | c.2.56 (0.78) | Ceiling effects below 1.3% | ||||
OA patients from 75 primary care practices | d.2.31 (0.81) | ||||||
e.2.48 (0.86) | |||||||
f.2.01 (0.81) | |||||||
(Test-retest - overall 0.81; PA 0.77; DSD/DS 0.78; GS/T 0.82; PS/C 0.79; FU/C 0.85. | |||||||
Schmittdiel [10] | USA | Mean 2.7 | 71% completed all items, 90% completed 17+ | Relationships similar for subgroup by disease | Significant relationship with higher quality of life (OR 1.2); no relationship with adherence to medications (OR 1.06) | ||
4108/6673 (61%) | Higher ratings of health care (OR 2.36), | Significantly associated with greater engagement in self management behaviours (OR 1.21 to 1.41); use of self management services (OR 1.4) | |||||
Private health care members on one of six chronic disease registers | |||||||
Szecenyi [21] | Germany | DMP/Non-DMP | Mean 3.2 DMP versus 2.68 non-DMP (significant p=0.001) and across all subscales except patient activation (p=0.05), greatest mean difference in F/C, least in PA | ||||
German language version | 1532/3546 (42.2%) | a.3.26/2.86 | |||||
(1,399 valid responses = 39%) | b.3.26/3.09 | ||||||
PACIC 5As | Patients with type 2 diabetes in primary care, in or outside disease management programmes (DMPs) | c.3.52/3.29 | |||||
d.2.91/2.50 | |||||||
e.3.39/3.04 | |||||||
f.3.13/2.70 | |||||||
Taggart [14] | Australia | S 1 | S 2 | Sample 1: 73% completed all 20 items; 95% completed at least 17 items. | EFA, both 2 factor solutions, 59% & 61% variance | Higher PACIC scores associated with higher patient self-rated health | Degree/diploma, retired, hypertension/IHD & greater duration of disease had negative associations with both factors and total PACIC scores; Employed and married/CH had negative associations with planned care factor and total PACIC score |
Sample 1: 2552/2642 (96%) (2642 of 3349 asked & consented to take part) | a. 3.01 | a.3.07 | Sample 2: 79% completed all 20 items; 95% completed at least 17 items. | F1 SDM and SM (12 items across four scale) (alpha 0.939 & 0.943) | SDM and AM positively associated with good health | ||
F2 Planned care (8 items across 3 scales) (Alphas 0.883 and 0.878) | |||||||
Sample 2: 963/1000 (96%) (1000 out of 4167 consented to take part) | |||||||
Patients with CHD, hypertension and/or T2 diabetes in general practice | |||||||
Wensing [22] | Netherlands | a. 2.9 (0.93) | 22-35% missing data. Items 15, 17 & 20 had >30% non response | PCA – five factors | Association between PACIC and EUROPEP aggregated scores all positive as expected. | Higher enablement in patients associated with lower PACIC scores – contrary to expectations | |
Dutch language version | 165 (72%) | b. 3.2 (0.85) | Lowest response category used by >30% for 11 items. (7-76%) | (70% variance explained; KMO 0.844; Bartlett’s p=0.000) | |||
Randomly sampled patients with diabetes or COPD from four general practices (involved in a programme to enhance structured diabetes care) | c. 3.5 (0.75) | Highest response category used by >30% for 6 items (10 – 54%) | Matched three pre- defined domains (but not delivery system/practice design nor follow up/co-ordination) | ||||
d. 2.5 (0.81) | |||||||
e. 3.3 (0.87) |
Methods
PACIC
Item | Missing (%) | Floor/ceiling (% valid) |
---|---|---|
Asked about my ideas when we made a treatment plan | 13.0 | |
Given choices about treatment to think about | 11.2 | |
Asked to talk about any problems with my medicines or their effects | 9.6 | |
Given a written list of things I should do to improve my health | 10.8 | |
Satisfied that my care was well organised | 10.8 | |
Shown how what I did to take care of myself influenced my condition | 14.1 | |
Asked to talk about my goals in care for my condition(s) | 13.9 | |
Helped to set specific goals to improve my eating or exercise | 13.8 | |
Given a copy of my treatment plan | 15.6 | |
Encouraged to go to a specific group or class to help me cope with my long-term condition(s) | 14.8 | |
Asked questions, either directly or on a survey, about my health habits | 13.5 | |
Sure that my doctor or nurse thought about my values, beliefs and traditions when they recommended treatments to me | 14.4 | |
Helped to make a treatment plan that I could carry out in my daily life | 15.9 | |
Helped to plan ahead so I could take care of my condition(s) even in hard times | 15.7 | |
Asked how my long-term condition(s) affects my life | 14.5 | |
Contacted after a visit to see how things were going | 14.9 | |
Encouraged to attend programs in the community that could help me | 15.5 | |
Referred to a dietician or nutritionist | 14.8 | |
Told how my visits with other types of doctors, like an eye doctor or surgeon, helped my treatment | 14.8 | |
Asked how my visits with other doctors were going | 14.1 | |
Patient activation scale | 11.2 | 20.9%, 5.0% |
Delivery system design subscale | 12.4 | 3.7%, 5.0% |
Goal setting subscale | 14.0 | 14.2%, 1.3% |
Problem solving subscale | 15.7 | 14.7%, 5.1% |
Follow up subscale | 14.7 | 30.4%, 1.0% |
PACIC total score | 14.6 | 2.1%, 0.3% |
Demographic and clinical characteristics
Measures of quality of care
(a) Shared decision making
(b) Quality of care for long-term conditions
(c) Satisfaction with primary care
Analysis
(a) Acceptability
(b) Reliability
(c) Validity
Results
Characteristic | Values are % or mean (SD) | |
---|---|---|
Gender | Male | 51.3 |
Age | 18 to 49 | 17.5 |
50 to 64 | 30.8 | |
65 to 74 | 28.4 | |
75+ | 23.3 | |
Self reported long-term conditions | ||
One | 20.5 | |
Two | 28.3 | |
Three | 20.5 | |
Four or more | 30.6 | |
Main professional responsible for care of long-term conditions* | ||
Primary care (GP or nurse) | 86.2 | |
Other | 13.8 | |
Highly satisfied with primary care | 56.2 | |
Shared decision making (HCCQ) | 71.8 (26.2) | |
High rating of shared decision making (HCCQ) | 48.1 | |
Quality of care for long-term conditions (QIPP) | 3.3 (0.67) |
Acceptability
Descriptives
Reliability
Validity (structure)
Complete case data | Complete case plus imputed data | |||
---|---|---|---|---|
Criterion for ‘Good’ Fit | Maximum likelihood | Asymptotically distribution-free | Maximum likelihood | |
N
| 1,846 | 1,846 | 2,040 | |
χ
2
(d.f.)
| non-significant | 3,535.3 (160)* | 1,576.2 (160)* | 3,895.3 (160)* |
Inter-factor correlation
| 0.604 to 0.972 | 0.684 to 0.919 | 0.596 to 0.967 | |
NFI
| ≥ .90 | 0.840 | 0.572 | 0.840 |
CFI
| ≥ .95 | 0.846 | 0.595 | 0.846 |
RMSEA
| < .08 | 0.107 | 0.069 | 0.107 |
SRMR
| < .08 | 0.068 | 0.092 | 0.068 |
Validity (construct)
External variable | N | Co-efficient | 95% CI | % variance |
---|---|---|---|---|
Female gender | 1787 | −0.18 | −0.25 to −0.12 | 0.01 |
Age | 1787 | |||
up to 49 | Reference | −0.19 to 0.08 | 0.01 | |
50–64 | −0.05 | −0.19 to 0.12 | ||
65–74 | −0.03 | −0.36 to −0.04 | ||
75+ | −0.20 | |||
Conditions | 1787 | |||
1 | Reference | 0.01 | ||
2 | −0.04 | −0.18 to 0.11 | ||
3 | −0.16 | −0.32 to −0.01 | ||
−0.12 | −0.27 to 0.04 | |||
4+ | ||||
Main professional responsible for long-term condition not primary care | 1652 | −0.01 | −0.11 to 0.10 | 0.00 |
GP visits in 6 months | 1787 | 0.00 | ||
0 | Reference | |||
1 | 0.03 | −0.09 to 0.15 | ||
2 | 0.12 | −0.01 to 0.25 | ||
3 | 0.14 | 0.02 to 0.28 | ||
4+ | 0.11 | −0.03 to 0.25 |
Variable | N | Spearman rank correlation | p |
---|---|---|---|
Satisfaction with primary care | 1827 | 0.24 | <0.001 |
Shared decision making (HCCQ) | 1780 | 0.47 | <0.001 |
Quality of care for long-term conditions (QIPP) | 1817 | 0.54 | <0.001 |