Background
Methods
Nijmegen continuity questionnaire
Translation and adaption
Study population and data collection
Study population % (N = 984) | Non-responders (%) (N = 1868) |
P value | |
---|---|---|---|
Patient gender | |||
Female | 63.4 | 67.2 | 0.043*
|
Male | 36.6 | 32.8 | |
Age (mean(SD)) | 58.1 (14.1) | 55.6 (16.7) | 0.001**
|
Proportions in age groups | |||
< 40 years | 10.2 | 17.2 | <0.001*
|
40–49 years | 17.6 | 21.0 | |
50–59 years | 24.7 | 22.5 | |
60–69 years | 25.4 | 15.8 | |
≥ 70 years | 22.1 | 23.5 | |
Reported diseases, grouped | |||
Musculoskeletal | 70.9 | ||
Cardiovascular | 35.5 | ||
Respiratory | 23.3 | ||
Neurology | 13.8 | ||
Cancer | 15.4 | ||
Endocrinology | 16.5 | ||
Skin | 21.4 | ||
Urinary tract | 4.6 | ||
Mental health | 23.9 | ||
Sum reported diseases, according to list above | |||
1 | 30.0 | ||
2 | 35.2 | ||
3 or more | 34.8 | ||
Referred by | |||
General practitioner | 61.6 | ||
Specialists | 27.9 | ||
Others / missing | 10.5 | ||
Use of health service (≥1 contacts last 12 months): | |||
GP | 97.3 | ||
Specialist, hospital | 64.4 | ||
Specialist, private | 35.7 | ||
Specialist total (hospital and/or private) | 75.6 | ||
Psychologist | 12.6 | ||
Physiotherapist | 60.6 | ||
Occupational therapist | 10.7 | ||
Home care contact | 10.7 | ||
Hospitalized | 48.4 | ||
Stay in rehabilitation institution | 22.6 | ||
Stay in a nursing home | 2.3 |
Statistical analyses
Results
Item groups | Responses to Likert scale 1–5b
| Do not knowb
| Missingc
| ||||
---|---|---|---|---|---|---|---|
n (%) | Mean (SD) | % lowest | % highest | n (%) | All within item group, n (%) | other, n (%) | |
About GP | |||||||
GP1 | 955 (97.1) | 3.99 (0.95) | 2.0 | 33.3 | 2 (0.2) | 15 (1.5) | 12 (1.2) |
GP1 | 955 (97.1) | 4.02 (0.84) | 1.6 | 40.2 | 9 (0.9) | 15 (1.5) | 5 (0.5) |
GP3 | 932 (94.7) | 4.19 (0.80) | 1.0 | 37.6 | 14 (1.4) | 15 (1.5) | 23 (2.3) |
GP4 | 907 (92.2) | 3.58 (1.15) | 5.1 | 24.9 | 43 (4.4) | 15 (1.5) | 19 (1.9) |
GP5 | 918 (93.3) | 3.63 (1.07) | 3.4 | 21.4 | 30 (3.1) | 15 (1.5) | 21 (2.1) |
GP6 | 878 (89.2) | 3.36 (1.21) | 8.9 | 19.1 | 64 (6.5) | 15 (1.5) | 27 (2.7) |
GP7 | 900 (91.5) | 3.78 (0.98) | 3.6 | 24.0 | 40 (4.1) | 15 (1.5) | 29 (3.0) |
GP8 | 882 (89.6) | 3.41 (1.10) | 6.1 | 17.0 | 57 (5.8) | 15 (1.5) | 30 (3.1) |
Team primary care | |||||||
TPC1 | 454 (46.1) | 2.92 (1.00) | 9.5 | 4.9 | 209 (21.2) | 316 (32.1) | 5 (0.5) |
TPC2 | 428 (43.5) | 2.91 (0.92) | 7.7 | 4.2 | 230 (23.4) | 316 (32.1) | 10 (1.0) |
TPC3 | 456 (46.3) | 2.95 (0.99) | 8.8 | 4.6 | 200 (20.3) | 316 (32.1) | 12 (1.2) |
TPC4 | 438 (44.5) | 2.76 (0.99) | 11.6 | 3.9 | 220 (22.4) | 316 (32.1) | 10 (1.0) |
About specialist | |||||||
SP1 | 617 (62.7) | 2.94 (1.18) | 13.0 | 10.2 | 32 (3.3) | 332 (33.7) | 3 (0.3) |
SP2 | 586 (59.6) | 3.48 (1.08) | 5.1 | 16.0 | 57 (5.8) | 332 (33.7) | 9 (0.9) |
SP3 | 556 (56.5) | 3.53 (1.05) | 4.7 | 16.9 | 79 (8.0) | 332 (33.7) | 17 (1.7) |
SP4 | 563 (57.2) | 2.57 (1.17) | 20.3 | 7.5 | 75 (7.6) | 332 (33.7) | 14 (1.4) |
SP5 | 574 (58.3) | 2.71 (1.18) | 17.4 | 7.7 | 62 (6.3) | 332 (33.7) | 16 (1.6) |
SP6 | 535 (54.4) | 2.95 (1.14) | 17.4 | 7.9 | 105 (10.7) | 332 (33.7) | 12 (1.2) |
SP7 | 558 (56.7) | 3.31 (1.11) | 9.9 | 13.3 | 83 (8.4) | 332 (33.7) | 11 (1.1) |
SP8 | 534 (54.3) | 2.86 (1.10) | 17.4 | 8.1 | 101 (10.3) | 332 (33.7) | 17 (1.7) |
Team specialised care | |||||||
TSP1 | 447 (45.4) | 3.31 (1.03) | 6.9 | 8.8 | 92 (9.4) | 443 (45.0) | 2 (0.2) |
TSP2 | 430 (43.7) | 3.34 (0.99) | 5.4 | 8.8 | 106 (10.8) | 443 (45.0) | 5 (0.5) |
TSP3 | 438 (44.5) | 3.28 (1.01) | 6.6 | 8.5 | 96 (9.8) | 443 (45.0) | 7 (0.7) |
TSP4 | 426 (43.3) | 3.14 (1.06) | 8.9 | 8.5 | 112 (11.4) | 443 (45.0) | 3 (0.3) |
Between GP and specialist | |||||||
TB1 | 534 (54.3) | 3.43 (0.98) | 5.2 | 9.9 | 136 (13.8) | 306 (31.1) | 8 (0.8) |
TB2 | 502 (51.0) | 3.27 (0.96) | 5.2 | 8.8 | 161 (16.4) | 306 (31.1) | 15 (1.5) |
TB3 | 524 (53.3) | 3.37 (0.98) | 5.5 | 9.4 | 139 (14.1) | 306 (31.1) | 15 (1.5) |
TB4 | 504 (51.2) | 3.21 (1.00) | 6.6 | 8.3 | 163 (16.6) | 306 (31.1) | 11 (1.1) |
Personal continuity - care provider knows me | GP | Specialist | |
Subscale items: |
IRC
a
|
IRC
a
| |
I know this care provider well
|
0.78
|
0.81
| |
This care provider knows my medical history well
|
0.80
|
0.82
| |
This care provider always remembers what he/she did during my last visit(s)
|
0.76
|
0.75
| |
This care provider knows my family circumstances well
|
0.75
|
0.77
| |
This care provider knows well what I do in my day-to-day life
|
0.72
|
0.80
| |
Total subscale score (SD) | 3.92 (0.82) | 3.05 (1.00) | |
Patients with lowest subscale score (floor effect), n (%) | 0.7 | 3.6 | |
Patients with highest subscale score (ceiling effect), n (%) | 14.7 | 5.2 | |
Internal consistency (Cronbach alpha) | 0.91 | 0.92 | |
Personal continuity - care provider shows commitment | GP | Specialist | |
Subscale items: |
IRC
a
|
IRC
a
| |
This care provider contacts me when necessary without me having to ask him/her to do so
|
0.68
|
0.75
| |
This care provider knows well what I think is important when it comes to my care
|
0.68
|
0.76
| |
This care provider maintains enough contact with me when I am seen by other care providers
|
0.73
|
0.79
| |
Total subscale score (SD) | 3.51 (0.96) | 3.05 (1.0) | |
Patients with lowest subscale score (floor effect), n (%) | 3.1 | 9.1 | |
Patients with highest subscale score (ceiling effect), n (%) | 11.8 | 5.4 | |
Internal consistency (Cronbach alpha) | 0.84 | 0.88 | |
Team/cross-boundary continuity - | within primary care | within specialized care | between GP and specialist |
Subscale items: |
IRC
a
|
IRC
a
|
IRC
a
|
These care providers pass on information to each other well
|
0.97
|
0.92
|
0.86
|
These care providers work together well
|
0.89
|
0.94
|
0.90
|
The care given by these care providers is well-connected
|
0.89
|
0.91
|
0.85
|
These care providers always know well what the other care providers have done
|
0.88
|
0.88
|
0.84
|
Total subscale score (SD) | 2.88 (0.91) | 3.26 (0.98) | 3.33(0.91) |
Patients with lowest subscale score (floor effect), n (%) | 5.4 | 5.1 | 3.6 |
Patients with highest subscale score (ceiling effect), n (%) | 2.8 | 6.7 | 6.8 |
Internal consistency (Cronbach alpha) | 0.96 | 0.97 | 0.95 |
Factor structure
NCQ-N single items and subscales
Personal continuity | Team/cross boundary continuity | |||||||
---|---|---|---|---|---|---|---|---|
N | GP knows me | GP shows commitment | Specialist knows me | Specialist shows commitment | Within primary care | Within specialised care | Between GP and specialist | |
Personal continuity | ||||||||
GP knows me | 923 | 1.00 | ||||||
GP shows commitment | 900 | 0.73** | 1.00 | |||||
Specialist knows me | 563 | 0.25 ** | 0.26** | 1.00 | ||||
Specialists shows commitment | 552 | 0.22** | 0.34** | 0.82** | 1.00 | |||
Team/cross boundary continuity | ||||||||
Within primary care | 426 | 0.31** | 0.41** | 0.32** | 0.41** | 1.00 | ||
Within specialised care | 432 | 0.07 | 0.15** | 0.39** | 0.41** | 0.43** | 1.00 | |
Between GP and specialist | 499 | 0.46** | 0.60** | 0.41** | 0.50** | 0.52** | 0.50** | 1.00 |
Test-retest
Intra-class correlation | Bland-Altman plot | ||||
---|---|---|---|---|---|
N | Coefficient | 95% CI | Mean difference | 95% limits of agreement | |
Personal continuity | |||||
- GP knows me | 112 | 0.89 | 0.84 to 0.93 | 0.126 | −0.877 to 1.130 |
- GP shows commitment | 107 | 0.91 | 0.87 to 0.94 | 0.051 | −1.016 to 1.118 |
- Specialist knows me | 58 | 0.84 | 0.72 to 0.91 | −0.238 | −1.673 to 1.197 |
- Specialist shows commitment | 54 | 0.88 | 0.79 to 0.93 | −0.148 | −1.482 to 1.185 |
Team/cross boundary continuity | |||||
- Within primary care | 52 | 0.67 | 0.42 to 0.81 | −0.128 | −1.942 to 1.686 |
- Within specialised care | 38 | 0.81 | 0.64 to 0.90 | −0.228 | −1.557 to 1.101 |
- Between GP and specialist | 48 | 0.91 | 0.84 to 0.95 | −0.106 | −1.209 to 0.997 |