Multimorbidity and patient experience with general practice: A national cross-sectional survey in Norway.

BACKGROUND: Patient experience is an important indicator of the quality of healthcare. Patients with multimorbidity often face adverse health outcomes and increased healthcare utilisation. General practitioners play a crucial role in managing these patients. The main aim of our study was to perform an in-depth assessment of differences in patient-reported experience with general practice between patients living with chronic conditions and multimorbidity, and those with no chronic conditions. METHODS: We performed secondary analyses of a national survey of patient experience with general practice in 2021 (response rate 41.9%, n = 7,912). We described the characteristics of all survey respondents with no, one, two, and three or more self-reported chronic conditions. We assessed patient experience using four scales from the Norwegian patient experience with GP questionnaire (PEQ-GP). These scales were used as dependent variables in bivariate and multivariate analyses and for testing the measurement model, including confirmatory factor analysis and a multigroup CFA to assess measurement invariance. Sentiment and content analysis of free-text comments was also performed. RESULTS: Patients with chronic conditions consistently reported lower scores on the GP and GP practice experience scales, compared to those without chronic conditions. This pattern persisted even after adjustment for patient background variables. The strongest associations were found for the scale of "Enablement", followed by the scales of "GP" and "Practice". The subscale "Accessibility" did not correlate statistically significantly with any number of chronic conditions. The analysis of free-text comments echoed the quantitative results. Patients with multimorbidity stressed the importance of time spent on consultations, meeting the same GP, follow-up and relationship more often than patients with no chronic conditions. Our study also confirmed measurement invariance across patients with no chronic conditions and patients with multimorbidity, indicating that the observed differences in patient experience were a result of true differences, rather than artifacts of measurement bias. CONCLUSIONS: The findings highlight the need for the healthcare system to provide customised support for patients with chronic conditions and multimorbidity. Addressing the specific needs of patients with multimorbidity is a critical step towards enhancing patient experience and the quality of care in general practice.

Associations between nursing home care environment and unfinished nursing care explored. Secondary analysis of cross-sectional data.

Understanding unfinished nursing care and its relationship with modifiable care environment factors is crucial for the service delivery to long-term frail patients. This secondary analysis aimed to explore the associations between characteristics of the care environment and unfinished nursing care, as reported by nursing care workers in Norwegian nursing homes. Of 931 respondents (37% response rate) from 66 nursing homes, six care environment characteristics correlated with at least two types of unfinished nursing care. Resources and Multidisciplinary collaboration showed a positive association with all four unfinished care categories. Input and acknowledgement, Professional, or Interpersonal leadership were not associated to unfinished care. In summary, our findings suggest that nursing care workers reporting positive care environment descriptions also reported lower frequencies of unfinished nursing care. This study offers insights crucial for human resource management which ultimately can be used to improve patient outcomes in nursing homes.

Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

BACKGROUND: Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience. METHODS: The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models. RESULTS: About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales. CONCLUSIONS: Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.

Web-Based Public Ratings of General Practitioners in Norway: Validation Study.

BACKGROUND: Understanding the complex relationships among multiple strategies for gathering users' perspectives in the evaluation of the performance of services is crucial for the interpretation of user-reported measures. OBJECTIVE: The main objectives were to (1) evaluate the psychometric performance of an 11-item web-based questionnaire of ratings of general practitioners (GPs) currently used in Norway (Legelisten.no) and (2) assess the association between web-based and survey-based patient experience indicators. METHODS: We included all published ratings on GPs and practices on Legelisten.no in the period of May 5, 2012, to December 15, 2021 (N=76,521). The questionnaire consists of 1 mandatory item and 10 voluntary items with 5 response categories (1 to 5 stars), alongside an open-ended review question and background variables. Questionnaire dimensionality and internal consistency were assessed with Cronbach α, exploratory factor, and item response theory analyses, and a priori hypotheses were developed for assessing construct validity (chi-square analysis). We calculated Spearman correlations between web-based ratings and reference patient experience indicators based on survey data using the patient experiences with the GP questionnaire (n=5623 respondents for a random sample of 50 GPs). RESULTS: Web-based raters were predominantly women (n=32,074, 64.0%), in the age range of 20-50 years (n=35,113, 74.6%), and reporting 5 or fewer consultations with the GP each year (n=28,798, 64.5%). Ratings were missing for 18.9% (n=14,500) to 27.4% (n=20,960) of nonmandatory items. A total of 4 of 11 rating items showed a U-shaped distribution, with >60% reporting 5 stars. Factor analysis and internal consistency testing identified 2 rating scales: "GP" (5 items; α=.98) and "practice" (6 items; α=.85). Some associations were not consistent with a priori hypotheses and allowed only partial confirmation of the construct validity of ratings. Item response theory analysis results were adequate for the "practice" scale but not for the "GP" scale, with items with inflated discrimination (>5) distributed over a narrow interval of the scale. The correlations between the web-based ratings GP scale and GP reference indicators ranged from 0.34 (P=.021) to 0.44 (P=.002), while the correlation between the web-based ratings practice scale and reference indicators ranged from 0.17 (not significant) to 0.49 (P<.001). The strongest correlations between web-based and survey scores were found for items measuring practice-related experiences: phone availability (ρ=0.51), waiting time in the office (ρ=0.62), other staff (ρ=0.54-0.58; P<.001). CONCLUSIONS: The practice scale of the web-based ratings has adequate psychometric performance, while the GP suffers from important limitations. The associations with survey-based patient experience indicators were accordingly mostly weak to modest. Our study underlines the importance of interpreting web-based ratings with caution and the need to further develop rating sites.

Adaptation, modification, and psychometric assessment of a Norwegian version of the Basel extent of rationing of nursing care for nursing homes instrument (BERNCA-NH).

BACKGROUND: To our knowledge, no instrument has been developed and tested for measuring unfinished care in Norwegian nursing home settings. The Basel Extent of Rationing of Nursing Care for Nursing Homes instrument (BERNCA-NH) was developed and validated in Switzerland to measure the extent of implicit rationing of nursing care in nursing homes. The BERNCA-NH comprises a list of nursing care activities in which a care worker reports the frequency to which activities were left unfinished over the last 7 working days as a result of lack of time. The aim of this study was to adapt and modify a Norwegian version of the BERNCA-NH intended for all care workers, and assess the instruments' psychometric properties in a Norwegian nursing home setting. METHODS: The BERNCA-NH was translated into Norwegian and modified to fit the Norwegian setting with inputs from individual cognitive interviews with informants from the target population. The instrument was then tested in a web-based survey with a final sample of 931 care workers in 162 nursing home units in different parts of Norway. The psychometric evaluation included score distribution, response completeness and confirmatory factor analysis (CFA) of a hypothesised factor structure and evaluation of internal consistency. Hypothesised relation to other variables was assessed through correlations between the subscale scores and three global ratings. RESULTS: The Norwegian version of BERNCA-NH comprised four subscales labelled: routine care, 'when required' care, documentation and psychosocial care. All subscales demonstrated good internal consistency. The CFA supported the four-factor structure with fit statistics indicating a robust model. There were moderate to strong bivariate associations between the BERNCA-NH subscales and the three global ratings. Three items which were not relevant for all care workers were not included in the subscales and treated as single items. CONCLUSIONS: This study found good psychometric properties of the Norwegian version BERNCA-NH, assessed in a sample of care workers in Norwegian nursing homes. The results indicate that the instrument can be used to measure unfinished care in similar settings.

Development, adaptation and psychometric assessment of the extended brisbane practice environment measure for nursing homes (B-PEM-NH) for use in the Norwegian setting.

Care workers' work environment is known to be associated with patient and nurse outcomes. To our knowledge no questionnaire is available for assessing this environment for all care workers in the Norwegian nursing-home setting. This paper describes the development, adaptation and assessment of such a questionnaire: the extended Norwegian version of the Brisbane Practice Environment Measure for Nursing Homes (B-PEM-NH). This version was developed and assessed using semistructured interviews, a reference group meeting, translation, adaptation, and pretesting, and psychometric assessment including exploratory and confirmatory factor analyses, and retest. We tested hypotheses to assess relations to other variables. The final factor solution comprised 41 items and 9 factors: interpersonal leadership, professional development, resources, professional leadership, input and acknowledgement, patient and next-of-kin focus, multidisciplinary collaboration, language misunderstandings, and feeling unsafe. The assessment showed that the B-PEM-NH had good psychometric properties, suggesting that the questionnaire is suitable for application in similar settings.

Measuring nurses' perception of work environment: a scoping review of questionnaires.

BACKGROUND: Nurses' work environment has been shown to be associated with quality of care and organizational outcomes. In order to monitor the work environment, it is useful for all stakeholders to know the questionnaires that assess or evaluate conditions for delivering nursing care. The aim of this article is: to review the literature for assessed survey questionnaires that measure nurses' perception of their work environment, make a brief assessment, and map the content domains included in a selection of questionnaires. METHODS: The search included electronic databases of internationally published literature, international websites, and hand searches of reference lists. Eligible papers describing a questionnaire had to be; a) suitable for nurses working in direct care in general hospitals, nursing homes or home healthcare settings; and b) constructed to measure work environment characteristics that are amenable to change and related to patient and organizational outcomes; and c) presented along with an assessment of their measurement properties. RESULTS: The search yielded 5077 unique articles. For the final synthesis, 65 articles met inclusion criteria, consisting of 34 questionnaires measuring nursing work environments in different settings. Most of the questionnaires that we found were developed, and tested, for registered nurses in a general hospital setting. Six questionnaires were developed specifically for use in nursing home settings and one for home healthcare. The content domains covered by the questionnaires were both overlapping and unique and the terminology in use was inconsistent. The most common content domains in the work environment questionnaires were supportive managers, collaborative relationships with peers, busyness, professional practice and autonomy. CONCLUSIONS: The findings from this review enhance the understanding of how "work environment" can be measured by an overview of existing questionnaires and domains. Our results indicate that there are very many work environment questionnaires with varying content.