Measuring Primary Care Across 35 OECD Countries

• Published in: Annals of family medicine Vol. 19; no. 6; pp. 547 - 552
• Main Authors: Zyzanski, Stephen J., Gonzalez, Martha M., O’Neal, Jonathan P., Etz, Rebecca S., Reves, Sarah R., Stange, Kurt C.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2021; American Academy of Family Physicians
• Subjects: Family Medicine/General Medicine; Internal Medicine; international comparison; measure development; Methodology; primary care; quantitative methods: health status/QOL measurement; quantitative methods: health status/QOL measurement; measure development; primary care; international comparison
• ISSN: 1544-1709; 1544-1717; 1544-1717
• DOI: 10.1370/afm.2697

To examine the psychometric properties and scores of the Person-Centered Primary Care Measure (PCPCM) in 28 languages and 35 Organisation for Economic Co-operation and Development (OECD) countries. Using a paid online sampling service, we requested age- and sex-representative samples of 360 adults in each country. We administered the Person-Centered Primary Care Measure—a previously validated 11-item, patient-reported measure that was developed using what patients and clinicians said is most important about primary care. We also assessed construct validity through associations with demographics, the Patient-Enablement Instrument, number of years the person had been with their primary care physician and practice, whether the patient thought the doctor knowing the results would improve their care, and whether it was hard to complete the survey. We assessed the psychometric properties of the PCPCM in each country and report the summative and item-specific PCPCM scores for each country. The PCPCM exhibited solid psychometric properties across all languages and countries, with Cronbach’s alphas ranging from 0.88 to 0.95, and corrected item-total correlations ranging from 0.47 to 0.81, with the vast majority of countries ranging from the low 0.50s to the high 0.70s. Multiple analyses showed strong evidence of concurrent validity. With a potential range from a low of 1 to a high of 4, the overall mean score was 2.74, with a standard deviation of 0.19. Mean PCPCM scores ranged from the lowest in Sweden (2.28) to the highest in Turkey (3.08), with Germany ranking second (3.01), and the United States third (2.99). The internal consistency and concurrent validity of the PCPCM across multiple countries provides strong evidence of the coherence of the breadth of primary care functions that patients and clinicians say are important. The diversity of total and item-specific scores across countries provokes interesting hypotheses about the influence of each different country’s policies, practices, demographics, and culture on primary care, and provides a strong impetus for further ecological and individual data analyses using the Person-Centered Primary Care Measure.