ABSTRACT
Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57-0.75; positive to strong positive correlations; p < 0.0001] for all domains and the total score, strong internal consistency (Cronbach's α = 0.86 overall and 0.65-0.82 for individual subscales), and large responsiveness (1.11). The overall mean score percentage seemed to be moderate at 69.5 ± 8.8%. Gender and presence of chronic conditions did not seem to vary significantly with PACIC-20 subscale scores (p > 0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for "delivery system or practice design." Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital.
ABSTRACT
A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations - Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations - Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.
ABSTRACT
The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.
