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

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.