MCN National Workshop, Manchester, 090204

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The Universities of Dundee and St Andrews
Delivering health care through managed clinical
networks (MCNs) lessons from the North Patient
experience survey in four Scottish
MCNs Research team Professor Bruce Guthrie,
Professor Huw Davies, Professor Matt Sutton, Dr
Brian Williams, Dr Rosemary Rushmer, Dr Isabel
Walter, Dr Gail Greig, Dr Joanne Coyle, John
Connaghan
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Patient experience survey

• More limited than hoped because changing
  permissions and processes
• Single cross-sectional survey to people with type
  2 diabetes and previous myocardial infarction
• Eventually done via volunteer practices with no
  reminders, 20-25 response rate

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What did we ask?

• Service Satisfaction Survey
• Experience of change in care
• PACIC
• SF12 (quality of life)
• Resource use
• Demography and co-morbidity

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Satisfaction with services

• 15 satisfaction questions
• eg in an overall, general sense, how satisfied
  are you with the service you have received?
  (Very satisfied, mostly satisfied,
  indifferent/mildly satisfied, quite dissatisfied)
• Complicated response types
• 80 to 96 positive
• 0.3 to 9.0 very negative (but 13 lt 4)
• Not very helpful

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Change over time 1
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Change over time 2 - diabetes
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PACIC

• 26 questions, 5 domains
• Patient activation
• Delivery system and decision support
• Goal setting and tailoring
• Problem solving
• Follow up and co-ordination
• Doesnt vary with patient characteristics,
  associated with higher quality diabetes care in
  US
• All scored on a five point scale

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Example - goal setting/tailoring

• Over the past 6 months/1 year, when receiving
  medical care for my diabetes, I was
• Asked to talk about my goals in caring for my
  illness
• Helped to set specific goals to improve my eating
  or exercise
• Given a copy of my treatment plan
• Encouraged to go to a specific group or class to
  help me cope with my chronic illness
• Asked questions, either directly or on a survey,
  about my health habits

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PACIC mean scores
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PACIC mean scores
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PACIC mean scores
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PACIC mean scores
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Conclusion

• Limits of cross-sectional surveys
• Change over time hard to assess
• PACIC
• No differences between voluntary and mandated
  MCNs 4 years after mandation
• Other policy meantime (NSFs, QOF)...
• Typically responses are sometimes at best
• Comparable to beacon US organisation

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Patient activation

• Over the past 6 months/1 year, when receiving
  medical care for my diabetes, I was
• Asked for my ideas when we made a treatment plan
  (2.4)
• Given choices about treatment to think about
  (2.5)
• Asked to talk about any problems with my
  medicines or their effects (2.9)

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Delivery system/practice design

• Over the past 6 months/1 year, when receiving
  medical care for my diabetes, I was
• Given a written list of things I should do to
  improve my health (2.3)
• Satisfied that my care was well organised (4.0)
• Shown how what I did to take care of my illness
  influenced my condition (3.2)

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Goal setting/tailoring

• Over the past 6 months/1 year, when receiving
  medical care for my diabetes, I was
• Asked to talk about my goals in caring for my
  illness (2.4)
• Helped to set specific goals to improve my eating
  or exercise (2.8)
• Given a copy of my treatment plan (2.0)
• Encouraged to go to a specific group or class to
  help me cope with my chronic illness (1.9)
• Asked questions, either directly or on a survey,
  about my health habits (3.2)

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Problem solving in context

• Over the past 6 months/1 year, when receiving
  medical care for my diabetes, I was
• Sure that my doctor or nurse thought about my
  values and my traditions when they recommended
  treatment for me (3.5)
• Helped to make a treatment plan that I could do
  in my daily life (2.6)
• Helped to plan ahead so I could take care of my
  illness even in hard times (2.4)
• Asked how my chronic illness affects my life
  (2.6)

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Follow up and coordination

• Over the past 6 months/1 year, when receiving
  medical care for my diabetes, I was
• Contacted after a visit to see how things were
  going (2.4)
• Encouraged to attend programs in the community
  that could help me (1.9)
• Referred to dietician, health educator or
  counsellor (2.1)
• Told how my visits with other types of doctors
  helped my treatment (3.1)
• Asked how my visits with other doctors were going
  (2.4)

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Activities generally done (mean gt3)

• Patient activation (none out of 4)
• Delivery system (2 out of 3)
• Satisfied that my care was well organised (4.0)
• Shown how what I did to take care of my illness
  influenced my condition (3.2)
• Goal setting and tailoring (1 out of 5)
• Asked questions, either directly or on a survey,
  about my health habits (3.2)
• Problem solving in context (1 out of 4)
• Sure that my doctor or nurse thought about my
  values and my traditions when they recommended
  treatment for me (3.5)
• Follow up and co-ordination (1 out of 5)
• Told how my visits with other types of doctors
  helped my treatment (3.1)

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Activities rarely done (mean lt2)

• Patient activation (none out of 4)
• Delivery system (none out of 3)
• Goal setting and tailoring (1 out of 5)
• Encouraged to go to a specific group or class to
  help me coupe with my chronic illness (1.9)
• Problem solving in context (none out of 4)
• Follow up and co-ordination (1 out of 5)
• Encouraged to attend programs in the community
  that could help me (1.9)