Do older patients and their family caregivers agree about the quality of chronic illness care?

Erin R. Giovannetti, Lisa Reider, Jennifer Wolff, Evin D. Frick, Chad Boult, Donald M. Steinwachs, Cynthia Boyd

Research output: Contribution to journalArticle

Abstract

Objective. Family caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics. Design. Cross-sectional analysis. Participants. Multimorbid older (aged 65 and above) adults and their family caregivers (n = 247). Methods. Quality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw). Results. Agreement of caregivers' and patients' PACIC scores was low (Kw = 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw = 0.03 and 0.34, respectively, P <0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw = -0.05 and 0.31, respectively, P w = 0.25 and 0.15, respectively, P > 0.05). Conclusion. Patient-caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.

Original languageEnglish (US)
Article numbermzt052
Pages (from-to)515-524
Number of pages10
JournalInternational Journal for Quality in Health Care
Volume25
Issue number5
DOIs
StatePublished - Oct 2013

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Caregivers
Chronic Disease
Quality of Health Care
Patient Care
Qualitative Research
Cross-Sectional Studies
Delivery of Health Care

Keywords

  • Caregiver
  • Primary care
  • Quality of care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Do older patients and their family caregivers agree about the quality of chronic illness care? / Giovannetti, Erin R.; Reider, Lisa; Wolff, Jennifer; Frick, Evin D.; Boult, Chad; Steinwachs, Donald M.; Boyd, Cynthia.

In: International Journal for Quality in Health Care, Vol. 25, No. 5, mzt052, 10.2013, p. 515-524.

Research output: Contribution to journalArticle

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AU - Steinwachs, Donald M.

AU - Boyd, Cynthia

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N2 - Objective. Family caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics. Design. Cross-sectional analysis. Participants. Multimorbid older (aged 65 and above) adults and their family caregivers (n = 247). Methods. Quality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw). Results. Agreement of caregivers' and patients' PACIC scores was low (Kw = 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw = 0.03 and 0.34, respectively, P <0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw = -0.05 and 0.31, respectively, P w = 0.25 and 0.15, respectively, P > 0.05). Conclusion. Patient-caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.

AB - Objective. Family caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics. Design. Cross-sectional analysis. Participants. Multimorbid older (aged 65 and above) adults and their family caregivers (n = 247). Methods. Quality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw). Results. Agreement of caregivers' and patients' PACIC scores was low (Kw = 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw = 0.03 and 0.34, respectively, P <0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw = -0.05 and 0.31, respectively, P w = 0.25 and 0.15, respectively, P > 0.05). Conclusion. Patient-caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.

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