Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience

Abstract Introduction There are few sources of published data on intra-cluster correlation coefficients (ICCs) amongst patients with type 2 diabetes (T2D) and/or hypertension in primary care, particularly in low- and middle-income countries. ICC values are necessary for determining the sample sizes of cluster randomized trials. Hence, we aim to report the ICC values for a range of measures from a cluster-based interventional study conducted in Malaysia. Method Baseline data from a large study entitled Evaluation of Enhanced Primary Health Care interventions in public health clinics (EnPHC-EVA: Facility) were used in this analysis. Data from 40 public primary care clinics were collected through retrospective chart reviews and a patient exit survey. We calculated the ICCs for processes of care, clinical outcomes and patient experiences in patients with T2D and/or hypertension using the analysis of variance approach. Results Patient experience had the highest ICC values compared to processes of care and clinical outcomes. The ICC values ranged from 0.01 to 0.48 for processes of care. Generally, the ICC values for processes of care for patients with hypertension only are higher than those for T2D patients, with or without hypertension. However, both groups of patients have similar ICCs for antihypertensive medications use. In addition, similar ICC values were observed for clinical outcomes, ranging from 0.01 to 0.09. For patient experience, the ICCs were between 0.03 (proportion of patients who are willing to recommend the clinic to their friends and family) and 0.25 (for Patient Assessment of Chronic Illness Care item 9, Given a copy of my treatment plan). Conclusion The reported ICCs and their respective 95% confidence intervals for T2D and hypertension will be useful for estimating sample sizes and improving efficiency of cluster trials conducted in the primary care setting, particularly for low- and middle-income countries.

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Patient experience on self-management support among primary care patients with diabetes and hypertension

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzy252 ◽

2019 ◽

Vol 31 (7) ◽

pp. 37-43 ◽

Cited By ~ 3

Author(s):

Ming Tsuey Lim ◽

Yvonne Mei Fong Lim ◽

Xin Rou Teh ◽

Yi Lin Lee ◽

Siti Aminah Ismail ◽

...

Keyword(s):

Primary Care ◽

Patient Experience ◽

Educational Level ◽

Linear Regression Analysis ◽

Self Management ◽

Short Version ◽

Design Decision ◽

Management Support ◽

Cross Sectional Survey ◽

Primary Care Patients

Abstract Objective To determine the extent of self-management support (SMS) provided to primary care patients with type 2 diabetes (T2D) and hypertension and its associated factors. Design Cross-sectional survey conducted between April and May 2017. Setting Forty public clinics in Malaysia. Participants A total of 956 adult patients with T2D and/or hypertension were interviewed. Main Outcome Measures Patient experience on SMS was evaluated using a structured questionnaire of the short version Patient Assessment of Chronic Illness Care instrument, PACIC-M11. Linear regression analysis adjusting for complex survey design was used to determine the association of patient and clinic factors with PACIC-M11 scores. Results The overall PACIC-M11 mean was 2.3(SD,0.8) out of maximum of 5. The subscales’ mean scores were lowest for patient activation (2.1(SD,1.1)) and highest for delivery system design/decision support (2.9(SD,0.9)). Overall PACIC-M11 score was associated with age, educational level and ethnicity. Higher overall PACIC-M11 ratings was observed with increasing difference between actual and expected consultation duration [β = 0.01; 95% CI (0.001, 0.03)]. Better scores were also observed among patients who would recommend the clinic to friends and family [β = 0.19; 95% CI (0.03, 0.36)], when health providers were able to explain things in ways that were easy to understand [β = 0.34; 95% CI (0.10, 0.59)] and knew about patients’ living conditions [β = 0.31; 95% CI (0.15, 0.47)]. Conclusions Our findings indicated patients received low levels of SMS. PACIC-M11 ratings were associated with age, ethnicity, educational level, difference between actual and expected consultation length, willingness to recommend the clinic and provider communication skills.

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