Measuring Primary Care Across 35 OECD Countries

Stephen J. Zyzanski; Martha M. Gonzalez; Jonathan P. O’Neal; Rebecca S. Etz; Sarah R. Reves; Kurt C. Stange

doi:10.1370/afm.2697

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Table 1.

Psychometric Properties and Evidence of Concurrent Validity for the PCPCM in 35 Countries

Country	Language	Mean (SD)	α	Item-Total Corr	Years MD	Years With Practice	MD Results	PEI Corr	Age	Sex^{^a}	Form
Turkey	Turkish	3.08 (0.7)	0.95	0.70-0.81	0.0001^{^b}	0.034	0.0001	0.74	NS	F	NS
Germany	German	3.01 (0.62)	0.9	0.57-0.71	0.003	0.004	0.001	0.64	NS	NS	NS
United States	English	2.99 (0.77)	0.94	0.66-0.81	0.0001	0.0001	0.0001	0.69	NS	NS	NS
Belgium	Dutch or French	2.98 (0.63)	0.9	0.53-0.72	NS	NS	0.0001	0.57	NS	NS	NS
France	French	2.96 (0.69)	0.91	0.57-0.74	0.008	0.014	0.0001	0.62	0.047	NS	NS
Luxembourg	Luxembourgish	2.92 (0.64)	0.88	0.55-0.65	NS	NS	NS	0.67	NS	NS	NS
Austria	Austrian	2.92 (0.64)	0.9	0.52-0.78	0.0001	0.0001	0.0001	0.69	NS	M	NS
Australia	English	2.9 (0.7)	0.93	0.61-0.79	0.0001	0.01	0.0001	0.7	NS	NS	NS
Switzerland	German	2.87 (0.63)	0.9	0.50-0.69	NS	0.01	0.0001	0.62	NS	NS	NS
Spain	Spanish	2.87 (0.65)	0.92	0.61-0.78	0.0001	NS	0.0001	0.74	NS	NS	NS
Hungary	Hungarian	2.87 (0.72)	0.92	0.47-0.80	0.009	NS	0.0001	0.63	NS	NS	NS
Norway	Norwegian	2.85 (0.68)	0.92	0.64-0.74	0.008	0.009	0.0001	0.67	NS	NS	NS
New Zealand	English	2.82 (0.7)	0.92	0.56-0.77	0.001	0.004	0.0001	0.62	NS	NS	NS
Ireland	English	2.82 (0.69)	0.91	0.57-0.74	0.005	NS	0.0001	0.68	NS	NS	NS
Portugal	Portuguese	2.8 (0.63)	0.91	0.57-0.77	0.0001	0.021	0.003	0.67	NS	M	NS
Mexico	Spanish	2.78 (0.73)	0.92	0.57-0.78	0.0001	0.0001	0.0001	0.68	NS	NS	NS
Slovenia	Slovenian	2.77 (0.72)	0.93	0.61-0.76	0.0001	NS	0.0001	0.69	0.039	NS	NS
Italy	Italian	2.77 (0.77)	0.94	0.54-0.82	0.001	0.0001	0.0001	0.73	NS	M	NS
Denmark	Danish	2.77 (0.69)	0.91	0.52-0.77	0.0001	0.0001	0.0001	0.61	NS	NS	NS
Latvia	Latvian	2.76 (0.7)	0.91	0.58-0.73	NS	NS	0.0001	0.63	NS	NS	NS
Netherlands	Dutch	2.75 (0.69)	0.92	0.52-0.76	NS	NS	0.0001	0.59	NS	M	NS
Canada	English	2.75 (0.8)	0.95	0.69-0.83	0.0001	0.0001	0.0001	0.72	NS	NS	NS
Slovakia	Slovak	2.71 (0.69)	0.91	0.54-0.73	0.004	0.005	0.0001	0.71	NS	NS	NS
Estonia	Estonian	2.69 (0.66)	0.9	0.53-0.77	NS	NS	0.0001	0.57	0.03	NS	NS
Czech	Czech	2.69 (0.64)	0.9	0.51-0.71	NS	NS	0.0001	0.68	NS	NS	NS
United Kingdom	English	2.61 (0.73)	0.92	0.59-0.80	0.0001	NS	0.0001	0.71	NS	M	NS
Israel	Hebrew	2.61 (0.66)	0.89	0.48-0.73	0.039	NS	0.0001	0.63	NS	NS	NS
Finland	Finnish	2.56 (0.61)	0.91	0.57-0.73	0.0001	0.003	0.001	0.68	0.001	NS	NS
Greece	Greek	2.54 (0.63)	0.93	0.66-0.76	0.035	NS	0.005	0.67	0.002	NS	NS
Poland	Polish	2.52 (0.67)	0.9	0.48-0.75	0.0001	NS	0.0001	0.68	NS	NS	NS
Korea	Korean	2.5 (0.67)	0.92	0.60-0.75	NS	NS	0.0001	0.67	0.013	NS	NS
Lithuania	Lithuanian	2.47 (0.66)	0.89	0.47-0.73	0.0001	NS	0.0001	0.63	NS	NS	NS
Japan	Japanese	2.46 (0.67)	0.94	0.69-0.84	0.0001	0.0001	0.0001	0.73	NS	NS	0.0001
Chile	Spanish	2.41 (0.76)	0.92	0.56-0.77	0.0001	0.002	NS	0.73	0.02	M	0.04
Sweden	Swedish	2.28 (0.74)	0.93	0.67-0.80	0.0001	0.0001	0.0001	0.74	0.034	M	NS

Corr = correlation; Form = PCPCM correlation with whether the patient reported it was hard to complete the survey; MD Results = PCPCM correlation with patient report of whether the doctor knowing the results would improve their care; PEI–Cor = PCPCM correlation with score on the Patient Enablement Index; PCPCM = Person-Centered Primary Care Measure; Yrs MD = PCPCM correlation with number of years the patient had been with the physician; Yrs Pract = PCPCM correlation with number of years the patient had been with the practice.
Note: The Spanish and Portuguese translations were used with either European or Latin American versions, as appropriate to the country.
↵a Significant sex differences, P values range from Turkey (<.0001) to Austria (0.034).
↵b Bonferroni adjustment for multiple testing requires P <0.009 for associations to be significant within country.

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Table 2.

Person-Centered Primary Care Item Scores by Country (Ranked by Total Score)

Country	Total	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11
Turkey	3.08	3.3	3.2	3.2	2.9	2.8	2.9	3.1	3.0	3.1	3.2	3.1
Germany	3.01	3.2	3.1	3.2	3.0	3.3	2.6	3.0	2.8	3.0	3.0	2.9
United States	2.99	3.1	3.1	3.2	3.0	3.0	2.5	2.8	2.9	2.9	3.2	3.0
Belgium	2.98	3.1	3.0	3.3	2.9	3.2	2.6	3.0	3.0	2.8	3.1	2.9
France	2.96	3.2	3.0	3.3	3.0	3.2	2.5	2.8	2.9	2.5	3.2	2.9
Austria	2.92	3.3	3.1	3.2	3.0	3.2	2.4	2.9	2.6	2.7	3.0	2.7
Luxembourg	2.92	3.3	3.0	3.1	2.9	3.0	2.5	2.9	2.7	2.7	3.1	2.8
Australia	2.90	3.1	3.1	3.3	3.0	3.0	2.5	2.8	2.8	2.7	3.0	2.8
Spain	2.87	3.2	3.0	3.3	3.0	2.9	2.2	2.8	2.7	2.7	3.0	2.8
Hungary	2.87	3.1	2.8	3.2	3.0	3.0	2.8	2.8	2.8	2.4	3.0	2.6
Switzerland	2.87	3.1	3.0	3.1	3.0	3.0	2.4	2.9	2.7	2.7	2.9	2.8
Norway	2.85	3.0	3.0	3.0	2.8	2.9	2.6	2.9	2.7	2.7	2.9	2.8
Ireland	2.82	3.1	3.0	3.2	2.7	2.9	2.4	2.8	2.8	2.5	2.9	2.7
New Zealand	2.82	3.0	3.1	3.2	2.9	2.8	2.3	2.8	2.7	2.5	2.9	2.7
Portugal	2.80	3.1	3.0	3.2	2.9	2.9	2.1	2.8	2.6	2.4	3.0	2.8
Mexico	2.78	3.1	3.1	3.2	2.7	2.8	2.2	2.5	2.7	2.5	3.0	2.7
Denmark	2.77	3.0	2.9	3.1	2.8	2.6	2.9	2.8	2.6	2.5	2.7	2.8
Slovenia	2.77	2.9	2.8	3.1	2.8	2.9	2.3	2.9	2.7	2.6	2.9	2.6
Italy	2.77	3.0	2.8	3.0	2.6	3.0	2.2	2.7	2.8	2.8	2.9	2.7
Latvia	2.76	3.0	2.7	3.0	2.9	2.8	2.6	2.6	2.7	2.5	2.9	2.6
Canada	2.75	2.9	2.9	3.0	2.7	2.8	2.4	2.7	2.7	2.5	2.9	2.7
Netherlands	2.75	2.9	2.8	3.0	2.7	2.8	2.2	2.8	2.8	2.7	2.8	2.7
Slovak	2.71	3.1	3.0	3.1	2.8	2.9	2.2	2.8	2.6	2.0	2.8	2.5
Estonia	2.69	3.0	2.9	3.1	2.9	2.6	2.4	2.7	2.5	2.5	2.7	2.4
Czech	2.69	3.2	3.0	3.2	2.8	2.7	1.8	2.8	2.6	2.4	2.8	2.3
United Kingdom	2.61	2.9	3.0	3.0	2.8	2.5	2.1	2.5	2.4	2.4	2.7	2.5
Israel	2.61	2.8	2.8	3.1	2.5	2.7	2.1	2.8	2.5	2.0	2.8	2.6
Finland	2.56	3.0	3.0	2.9	2.7	2.3	1.7	2.7	2.3	2.1	2.8	2.7
Greece	2.54	2.6	2.6	2.9	2.5	2.6	2.4	2.5	2.6	2.2	2.7	2.5
Poland	2.52	2.9	2.7	2.9	2.6	2.8	2.1	2.4	2.2	2.2	2.5	2.3
Korea	2.50	3.0	2.9	2.8	2.6	2.1	2.0	2.3	2.4	2.3	2.6	2.5
Lithuania	2.47	2.9	2.7	2.9	2.6	2.5	1.8	2.5	2.2	2.1	2.7	2.3
Japan	2.46	2.7	2.7	2.6	2.3	2.4	2.1	2.6	2.3	2.4	2.5	2.5
Chile	2.41	2.7	2.6	2.9	2.5	2.2	1.7	2.1	2.3	2.3	2.7	2.4
Sweden	2.28	2.8	2.7	2.6	2.5	2.0	1.8	2.1	1.8	2.0	2.4	2.3

Q[uestion]1 = My practice makes it easy for me to get care; Q2 = My practice is able to provide most of my care; Q3 = In caring for me, my doctor considers all the factors that affect my health; Q4 = My practice coordinates the care I get from multiple places; Q5 = My doctor or practice knows me as a person; Q6 = My doctor and I have been through a lot together; Q7 = My doctor or practice stands up for me; Q8 = The care I get takes into account knowledge of my family; Q9 = The care I get in this practice is informed by knowledge of community; Q10 = Over time, my practice helps me to stay healthy; Q11 = Over time, my practice helps me to meet my goals.

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In brief

Measuring Primary Care Across 35 OECD Countries

Rebecca S. Etz and colleagues

Background Researchers administered the Person-Centered Primary Care Measure in 28 languages to 35 Organisation for Economic Cooperation and Development countries to examine the reliability and validity of the measure and to explore the differences in primary care across 35 OECD countries. The PCPCM is an 11-item, patient-reported measure developed in 2017 to assess primary care qualities such as health care accessibility, advocacy, community context, family context, goal-oriented care, health promotion, integration and relationship. Survey constructs are based on what patients, clinicians and, to a lesser extent, payers say is most important to them in primary care.

What This Study Found The PCPCM showed solid psychometric properties across all languages and countries, according to the study.

Implications

The results provide evidence to primary care researchers that the PCPCM is able to collect data with high comparability, despite differences in geography, culture, or language. The authors encourage further ecological and individual data analyses of the PCPCM to learn about different approaches to health care across different countries.