Quantitative Testing of the Primary Care Outcomes Questionnaire

Problem

As the first contact for any health-related need, primary care clinicians often address multiple patient problems, with a range of possible outcomes. There is currently no patient-reported outcome measure (PROM) which covers this range of outcomes. This abstract describes the quantitative testing of the Primary Care Outcomes Questionnaire (PCOQ) a 27-item questionnaire designed to capture outcomes which patient seek and primary care clinicians can influence. It was theorised that these outcomes, derived from prior qualitative work, occupied 4 domains: (1) Health Status (2) Internal Health Empowerment (3) External Health Empowerment (4) Health Perceptions. The research aimed to test this theory, and quantitatively test the validity of the PCOQ.

Approach

Patients in 5 GP waiting rooms in Bristol, North Somerset and South Gloucestershire, completed the PCOQ before their consultation, taking a second questionnaire for completion after 1 week. The second questionnaire contained both the PCOQ and some validated comparator PROMs which measured health status, activation, illness perception, enablement and perceived change since the last appointment.

The sampling target was 600 patients from GP waiting rooms, and 240 (40%) for the follow-up questionnaire. The data analysis included:

1. Factor analysis on the 600 PCOQ questionnaires and calculation of factor scores.

2. Linear regression and correlation coefficients between the factor scores and the comparator questionnaires.

3. Effect sizes of the change in PCOQ factor scores.

Findings

602 patients completed the PCOQ in GP waiting rooms, and 264 of these returned the second set of questionnaires.

Exploratory factor analysis on the 602 PCOQ questionnaires revealed 4 dimensions, which were similar but not identical to the hypothesised domains:

1. Health Status: includes physical and emotional symptoms, health concerns and the effect of symptoms on life.

2. Health Knowledge and Self-Care: patient understanding of health problems, the ability to stay healthy, manage symptoms and prevent future health problems.

3. Confidence in Health Plan: patient confidence in and adherence to health plans.

4. Confidence in Health Provision: patient confidence that they can access appropriate primary healthcare when they need it, including a medically competent clinician who will listen to them.

Each dimension was associated as expected with respective comparator PROMs. For the sub-set of patients who said their main problem had improved, small to moderate effect sizes were observed for each construct. Those who said their main problem had not improved showed a negligible effect size.

Consequences

The PCOQ was acceptable to patients and easily administered in GP waiting rooms. The questionnaire showed a clear factor structure and evidence for construct validity, including responsiveness to change. This new PROM is a promising tool, which can be used to assess the outcome of primary care interventions from a patient perspective.