Accessibility from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments

Abstract

The operational definition of first-contact accessibility is “the ease with which a person can obtain needed care (including advice and support) from the practitioner of choice within a time frame appropriate to the urgency of the problem”; accommodation is “the way healthcare resources are organized to accommodate a wide range of patients’ abilities to contact healthcare providers and reach healthcare services, that is to say telephone services, flexible appointment systems, hours of operation, and walk-in periods.” Objective: To compare how well accessibility is measured in validated subscales that evaluate primary healthcare from the patient’s perspective. Method: 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare with four subscales that measure accessibility: the Primary Care Assessment survey (PCAs), the Primary Care Assessment Tool – short Form (PCAT-s, two subscales) and the first version of the EuROPEP (EuROPEP-I). scores were normalized to a 0-to-10 scale for descriptive comparison. Exploratory and confirmatory (structural equation modelling) factor analysis examined fit to operational definition, and item response theory analysis examined item performance on common constructs. Results: The subscales demonstrate similar psychometric measures to those reported by developers. The PCAT-s First-Contact utilization subscale does not fit the accessibility construct. The remaining three subscales load reasonably onto a single factor, presumed to be accessibility, but the best-fitting model has two factors: “timeliness of obtaining needed care” (PCAT-s First-Contact Access, some EuROPEP-I items) and “how resources are organized to accommodate clients” (PCAs Organizational Access and most of EuROPEP-I organization of care). Items in the PCAs and PCAT-s subscales have good discriminability. Conclusion: Only three of the four subscales measure accessibility; all are appropriate for use in Canada. The PCAT-s First-Contact Access subscale is the best measure for first-contact accessibility, and PCAs Organizational Accessibility has good metric properties and measures for accommodation.