Patient Portal Use, Perceptions of EHR Value, and Self-Rated Primary Care Quality among Older Adults: A Cross-Sectional Survey (Preprint)

BACKGROUND Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. OBJECTIVE The aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. METHODS We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship. RESULTS Moderate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; <i>P</i>=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. CONCLUSIONS Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.

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Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives.

10.21203/rs.3.rs-57447/v2 ◽

2020 ◽

Author(s):

Wichai Aekplakorn ◽

Paibul Suriyawongpaisal ◽

Samrit Srithamrongsaw ◽

Phanuwich kaewkamjonchai

Keyword(s):

Primary Care ◽

Structural Equation ◽

Health Care Services ◽

Chronic Care ◽

Care Quality ◽

Equation Modeling ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Mixed Effect ◽

Validated Questionnaire

Abstract Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focuses on strengthening primary care including training of the team to deliver healthcare based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients on the health care services after the implementation. Methods We conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered to 27 primary care units and 11 hospital Non-communicable diseases (NCDs) clinics in 11 provinces.The patients were interviewed at home using a validated questionnaire of the Patient Assessment of Chronic Illness Care (PACIC+). It contains 20 items from the original PACIC, which measure different parts of the CCM, and an additional 6 items assess the 5A Model including assess, advise, agree, assist, and arrange subscales. Upgraded primary care unit (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect models were employed to compare subscale of patient perception of the care quality between trained upgraded PCUs, upgraded PCUs, ordinary PCUs and NCD clinics.Results There was an independent association between every PACIC subscale (as a measure of CCM) and facility type with the maximum likelihood for patients of ordinary PCU reporting high to highest scores (ORs: 1.46-1.85; p<0.05) compared to hospital NCD clinics. This is also the case for patients: seeing the same doctor on repeated visits (ORs: 1.82-2.17; p<0.05) or having phone contacts of the providers (ORs:1.53-1.99; p<0.05). Similarly, across all of the 5A model subscales, ORs for patients attending ordinary PCU responded with high to highest scores were 1.48-2.10 times compared to those for patients attending hospital NCD clinics (p<0.05). Conclusions The training and allocation of family physician approach in PCU may not satisfy the patients’ perception on quality of chronic care. Further studies might focus on other factors such as mismatch between health workforce and workload as a key factor influencing the success of the policy implementation.

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Assessing a national policy on strengthening chronic care in primary care settings of a low-resource country using patients' perspectives.

10.21203/rs.3.rs-57447/v1 ◽

2020 ◽

Author(s):

Paibul Suriyawongpaisal ◽

Wichai Aekplakorn ◽

Samrit Srithamrongsaw ◽

Phanuwich Kaewkamjonchai

Keyword(s):

Primary Care ◽

Chronic Care ◽

Care Quality ◽

Local Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Mixed Effect ◽

Multiprofessional Team ◽

Primary Care Settings ◽

Healthcare Needs

Abstract Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focuses on strengthening primary care including training of the team to deliver healthcare based on the concept of Chronic Care Model(CCM). This study conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered to 25 primary care units and 16 hospital NCD clinics in 11 provinces (76 in total) to examine the effects of provider training and local health systems settings on patients’ perception of the chronic care quality.Methods A home-based interview with questionnaire was conducted on the patients in primary care settings. The questionnaire was adopted from the Thai version of the Patient Assessment of Chronic Illness Care (PACIC+) developed by the MacColl Institute for Healthcare Innovation. The questionnaire contains 20 items from the original PACIC, which measure different parts of the CCM, and an additional 6 items assess the 5A Model.Mixed effect models were employed to compare subscale of patient perception of the care quality between trained upgraded PCUs, upgraded PCUs, ordinary PCUs and NCD clinics. Upgraded PCUs were ordinary PCUs with the multiprofessional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input.Results Mixed effect models depicted an independent association between every PACIC subscale (as a measure of CCM) and facility type with the maximum likelihood for patients of ordinary PCU reporting high to highest scores (ORs: 1.52-1.76; p<0.05) compared to hospital NCD clinics. This is also the case for patients: seeing the same doctor on repeated visits (ORs: 1.66-1.87; p<0.05) or having phone contacts of the providers (ORs:1.42-1.63; p<0.05). Similarly, across all of the 5A model subscales, ORs for patients attending ordinary PCU responded with high to highest scores were 1.4-2.0 times compared to those for patients attending hospital NCD clinics(p<0.05). Conclusions We could not find evidence to support effectiveness of the training approach. The training failure might indicate a need to address mismatch between health workforce and workload. It also indicates a need to incorporate fidelity check into any training program for chronic care addressing the complex healthcare needs.

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AGEISM IN HEALTH CARE: 72 IS NOT A DIAGNOSIS

Innovation in Aging ◽

10.1093/geroni/igz038.307 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S79-S79

Author(s):

Phyllis A Greenberg ◽

Tarynn Johnson

Keyword(s):

Mental Health ◽

Older Adults ◽

Primary Care ◽

Older Patients ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Accepted Part ◽

Perceptions Of Aging ◽

Primary Care Clinicians ◽

Mental Slowness

Abstract This poster examines what value, if any, there is in using age as a predictor or impetus for testing, examining and diagnosing older adults. In a cross sectional survey (Davis et al. (2011) used the Expectations Regarding Aging Scale to assess primary care clinicians perceptions of aging in the domains of physical/mental health and cognitive functioning. Sixty-four percent of respondents agreed with the statement “Having more aches and pains is an accepted part of aging while 61% agreed that the “Human body is like a car when it gets old it gets worn out. And 51% agreed that one should expect to become more forgetful with age while 17% agreed that mental slowness is impossible to escape. How might these attitudes and biases effect how older adults are diagnosed, heard, spoken to, and treated (medical treatment as well as patient/professional interaction)? Are older patients/clients underserved or over served? Is forgetting where you put your keys always or even usually a sign of dementia? How helpful then is the use of age and are there other factors that should and can take precedence? What do we know and what don’t we know if we know someone’s age? Successful and innovative tools are explored that acknowledge age biases and strategies are presented to change age biases in education, training and practice.

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Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives.

10.21203/rs.3.rs-57447/v3 ◽

2021 ◽

Author(s):

Wichai Aekplakorn ◽

Paibul Suriyawongpaisal ◽

Samrit Srithamrongsaw ◽

Phanuwich kaewkamjonchai

Keyword(s):

Primary Care ◽

Structural Equation ◽

Chronic Care ◽

Care Quality ◽

Equation Modeling ◽

Patient Assessment ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Mixed Effect ◽

Validated Questionnaire

Abstract Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focused on strengthening primary care based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients about the health care services after the implementation. Methods We conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered with 27 primary care units and 11 hospital non-communicable diseases (NCDs) clinics in 11 provinces.The patients were interviewed using a validated questionnaire of the Patient Assessment of Chronic Illness Care. Upgraded primary care units (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect logistic models were employed to examine the association of subscales (high vs low score) of patient perception of the care quality with type of PCUs.Results Compared to hospital NCD clinics, ordinary PCUs were the best in the odds of receiving high score for every CCM subscale (ORs: 1.46-1.85; p<0.05), whereas the trained upgraded PCUs were better in terms of follow-up (ORs:1.37; p <0.05), and the upgraded PCU did not differ in all domains. According to the 5 A model subscales, patient assessment also revealed better performance of ordinary PCUs in all domains compared to hospital NCD clinics whereas upgraded PCUs and trained upgraded PCUs did so in some domains. Seeing the same doctor on repeated visits (ORs: 1.82-2.17; p<0.05) or having phone contacts with the providers (ORs:1.53-1.99; p<0.05) were found beneficial using CCM subscales and the 5A model subscales. However, patient assessment by both subscales did not demonstrate a statistically significant association across health insurance status.Conclusions The policy implementation might not satisfy the patients’ perception on quality of chronic care according to the CCM and the 5A model subscale. However, the arrangement of chronic care with patients seeing the same doctors or patients having telephone contact with healthcare providers may satisfy the patients’ perceived needs.

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Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives

BMC Health Services Research ◽

10.1186/s12913-021-06220-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wichai Aekplakorn ◽

Paibul Suriyawongpaisal ◽

Samrit Srithamrongsawadi ◽

Phanuwich Kaewkamjonchai

Keyword(s):

Primary Care ◽

Structural Equation ◽

Chronic Care ◽

Care Quality ◽

Equation Modeling ◽

Patient Assessment ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Mixed Effect ◽

Validated Questionnaire

Abstract Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focused on strengthening primary care based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients about the health care services after the implementation. Methods We conducted a cross-sectional survey of 4071 patients with hypertension and/or diabetes registered with 27 primary care units and 11 hospital non-communicable diseases (NCDs) clinics in 11 provinces. The patients were interviewed using a validated questionnaire of the Patient Assessment of Chronic Illness Care. Upgraded primary care units (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect logistic models were employed to examine the association of subscales (high vs low score) of patient perception of the care quality with type of PCUs. Results Compared to hospital NCD clinics, ordinary PCUs were the best in the odds of receiving high score for every CCM subscale (ORs: 1.46–1.85; p < 0.05), whereas the trained upgraded PCUs were better in terms of follow-up (ORs:1.37; p < 0.05), and the upgraded PCU did not differ in all domains. According to the 5 A model subscales, patient assessment also revealed better performance of ordinary PCUs in all domains compared to hospital NCD clinics whereas upgraded PCUs and trained upgraded PCUs did so in some domains. Seeing the same doctor on repeated visits (ORs: 1.82–2.17; p < 0.05) or having phone contacts with the providers (ORs:1.53–1.99; p < 0.05) were found beneficial using CCM subscales and the 5A model subscales. However, patient assessment by both subscales did not demonstrate a statistically significant association across health insurance status. Conclusions The policy implementation might not satisfy the patients’ perception on quality of chronic care according to the CCM and the 5A model subscale. However, the arrangement of chronic care with patients seeing the same doctors or patients having telephone contact with healthcare providers may satisfy the patients’ perceived needs.

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Comparison of patient perceptions of primary care quality across healthcare facilities in Korea: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0230034 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0230034 ◽

Cited By ~ 1

Author(s):

Yongjung Cho ◽

Heeyoung Chung ◽

Hyundeok Joo ◽

Hyung Jun Park ◽

Hee-Kyung Joh ◽

...

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Care Quality ◽

Patient Perceptions ◽

Sectional Study ◽

Cross Sectional ◽

Healthcare Facilities ◽

Primary Care Quality

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Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality

BMJ Open ◽

10.1136/bmjopen-2013-003391 ◽

2013 ◽

Vol 3 (10) ◽

pp. e003391 ◽

Cited By ~ 5

Author(s):

Kate Honeyford ◽

Richard Baker ◽

M John G Bankart ◽

David Jones

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Cross Sectional Study ◽

Care Quality ◽

Sectional Study ◽

Cross Sectional ◽

Primary Care Quality

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Factors Associated With Discussions Regarding Place of Death Preferences Among Older Japanese: A JAGES Cross-Sectional Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120954813 ◽

2020 ◽

Vol 38 (1) ◽

pp. 54-61

Author(s):

Yuki Moriki ◽

Maho Haseda ◽

Naoki Kondo ◽

Toshiyuki Ojima ◽

Katsunori Kondo ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Primary Care Physicians ◽

Care Physician ◽

Place Of Death ◽

Multivariable Logistic Regression Analysis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Community Factors ◽

Factors Associated

In Japan, many adults prefer to die at home; however, few have their preferences actually come true. While discussions regarding place of death preferences (DPDPs) are important for older adults, they are poorly documented. Therefore, we investigated the factors associated with older Japanese men and women having DPDPs. We used cross-sectional survey data collected for the Japan Gerontological Evaluation Study (JAGES). We applied multivariable logistic regression analysis to calculate the odds ratio (ORs) of having DPDPs separately between men (n = 2,770) and women (n = 3,038) aged ≥ 75 years. We considered 17 potential factors associated with having DPDPs, which were classified as either demographic, healthcare, family, or community factors. Among participants, 50.1% had DPDPs: 1,288 men (44.3%) and 1,619 women (55.7%). Older adults, DPDPs were associated with 5 additional factors; e.g. having a primary care physician (ORs = 1.47 [men] and 1.45 [women]), as were those who gave family and friends advice (ORs = 1.26 [men] and 1.62 [women]), and having people who listened to their concerns (ORs = 1.70 [men] and 1.81 [women]). Among men, DPDPs were associated with 3 additional factors; e.g. humorous conversations with their spouse (OR = 1.60). Among women, only one factor—reading newspapers (OR = 1.43) was associated with having DPDPs. Social networks with primary care physicians, family members, and friends may be important factors in promoting DPDPs. These gender-based differences in older adults relating to DPDPs should be considered when developing interventions to promote advance care planning that includes DPDPs.

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Effect of Family Practice Contract Services on the Perceived Quality of Primary Care among Patients with Multimorbidity: A Cross-Sectional Study in Guangdong, China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010157 ◽

2021 ◽

Vol 19 (1) ◽

pp. 157

Author(s):

Jingyi Liao ◽

Mengping Zhou ◽

Chenwen Zhong ◽

Cuiying Liang ◽

Nan Hu ◽

...

Keyword(s):

Primary Care ◽

Family Practice ◽

Chronic Conditions ◽

Cross Sectional Study ◽

Care Quality ◽

Sectional Study ◽

Cross Sectional ◽

Primary Care Quality ◽

Quality Of Primary Care

Family practice contract services, an important primary-care reform policy for improving primary healthcare quality in China, incorporate patients with multiple chronic conditions into the priority coverage groups and focus on their management. This study aims to explore the family practice contract services’ effectiveness in improving the quality of primary care experienced by this population. A cross-sectional study using a three-stage sampling was conducted from January to March 2019 in Guangdong, China. A multivariable linear regression, including interaction terms, was applied to examine the associations between the contract services and primary care quality among people with different chronic conditions. The process quality of primary care was measured in six dimensions using the validated assessment survey of primary care (ASPC) scale. People with contract services scored higher in terms of quality of primary care than those without contract services. Contract services moderated the association between chronic condition status and primary care quality. Significantly positive interactions were observed in the patient-centred care dimension and negative interactions were reflected in the accessibility dimension. Our findings suggest that family practice contract services play a crucial role in improving patient-perceived primary care quality and provide emerging evidence that patients with multimorbidity tend to benefit more from the services, especially in patient-centred care.

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