268724 Development of the Primary Care Assessment Tool (PCAT) Spanish Version

Sunday, October 28, 2012

Ruth Ríos, PhD , School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, PR
Mario H. Rodríguez, PhD , School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, PR
Roberto Ramirez , Health Services Administration Department, School of Public Health of the University of Puerto Rico, San Juan, PR
Carlos Morales, MS , Department of health Services Admnistration, School of Public Health, San Juan, PR
Glena Calderon, MS , Puerto Rico-Florida Public Health Training Center, University of Puerto Rico, University of Puerto Rico, School of Public Health, San Juan, PR
Camille Velez, MS , Center for Evaluation and sociomedical Reesarch, School of Public Health, San Juan, PR
Introduction: Efforts to evaluate primary care in Puerto Rico (PR) using valid and reliable methods are limited or nonexistent. The Spanish-translation, cultural adaptation and test of the Primary Care Assessment Tool (PCAT) will make available a valid and reliable method of assessing the quality of a primary care system analogous to the US health system and with an ethnic group that represents a rising segment of the diverse US Latino population. Objective: Compare results of the PCAT Spanish version in four primary care settings with different management and financial arrangements. Methods: The translation and cultural adaptation of the PCAT followed the methods developed by Matías-Carrello and colleagues (2003): Spanish translation, experts' review, focus groups, back-translation, and pre-test. After the cultural adaptation, a cross-sectional designed survey was used to interview a sample of consumers (n= 270) of primary care services in four settings identified as the principal sources of primary health care for beneficiaries of the government's health insurance program: Community Health Centers (CDT for their Spanish acronym) operated by the municipalities; Community Health Centers (Private IPAs) that were sold as part of the government's privatization initiatives; community health centers operating under sponsorship of Community Health Center grants from the Bureau of Primary Care of the U.S. Public Health Service; and Primary Care Physician Group Practices (PCPGP). Descriptive and multivariate (Multiple Lineal Regression) statistical analyses were done using SPSS v17. Results: Findings from the focus groups show that all groups agreed that the literature definitions represent the ideal of what PC should be. However, due to financing or availability issues, the emergency room becomes the point of entry to receive care. Continuity of care is attained mainly by consumer initiatives. Participants recognize differences in the Cultural Competency construct meaning between the US and PR due to perceived population's cultural background homogeneity within the Island. Comprehensiveness, coordination and community-oriented care were identified as deficient in the current PC services. Survey results show statistically significant differences (p<.05) among the four settings only in the Comprehensiveness construct. Conclusion: Participants believe that the definition of PC was ideal, but concepts such as “family centered” and “community oriented practice” are unrealistic in their experience. Gaps are identified in perception of the implementation of PC in diverse community settings that must be taken into consideration in planning and evaluating health services.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Provision of health care to the public

Learning Objectives:
Describe methods used in the Spanish translation and cultural adaptation of the Primary Care Assessment Tool (PCAT). Compare primary care domains as measured by the PCAT among four settings identified as the principal sources of primary health care for beneficiaries of the Puerto Rico government’s health insurance program.

Keywords: Primary Care, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a faculty member of the Puerto Rico School of Public Health, Co-PI of the Puerto Rico-Florida Public Health Training Center, and Research Coordinator of the Puerto Rico Health Services Research Center. I have 16 years of experience teaching and doing Health Services Research and Program Evaluation. I was the Principal investigator of this project financed by AHRQ, and worked in collaboration with Dr. Barbara Starfield who developed the Primary Care Assessment Tool.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.