Measuring care alignment in general practice consultations for people with long-term conditions: an exploratory study

INTRODUCTION Chronic care Model (CCM) aims to make the care of people with long term conditions (LTC) planned, proactive and patient-centred. The patient assessment of chronic care (PACIC) and our recently developed modified PACIC (MPACIC) allow patient and provider views to be compared. AIM To explore the use of measures of care provision and receipt in primary care long-term conditions management and to assess congruity between patient and provider views of support. METHODS For this observational self-report study, 13 pairs of matched patient and provider dyads (patient/general practitioner and patient/practice nurse) were recruited from general practice. Patients with long-term conditions were asked to rate the support provided by their general practitioner and practice nurse, separately, using the PACIC instrument, a measure of care processes. The modified version for providers (MPACIC) was similarly administered, with GPs and PNs (herein referred to as practitioners) rating the care specifically provided to the 13 patients. Aggregated scores were compared and a case study example was used. RESULTS For 67% of ratings, patients and practitioners agreed (0 or 1 category difference) on the frequency of self-management support provision. Some disagreement was found for 19% of ratings, and considerable disagreement was found for 15%. The strongest agreement was found with Delivery System Design and the least with Goal Setting. Generally, there was little difference between patient/doctor and patient/nurse agreement. DISCUSSION Agreement between patients and practitioners regarding the level of self-management support received and provided was relatively high. This study demonstrates ways the PACIC and MPACIC can be used together to measure patient/practitioner agreement about long-term condition care provision.