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Table 2 Description of questionnaires used in studies to assess quality of relationships between patients and primary care providers in alphabetical order

From: Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review

Questionnaire Authors of the questionnaire or validation paper(s) Questionnaire Description Questionnaire Format Answer format Summary of validation work
Care Continuity Across Levels of Care Scale (CCAENA) Herndandez, A (2010) Aims to assess patients’ perspectives of assess care continuity across settings 138 items across three subscales:
1) Pt-PCP relational continuitya
2) Pt-Secondary Care provider relational continuity3) Transfer of information
6 point Likert scale on level of agreement with statements;
2 open ended
Pilot study on 1500 patients to confirm construct validity against predetermined subscales (all had eigenvalues greater than 1) and confirm internal consistency (Cronbach’s alpha 0.8–0.97) [31].
Chao Perception of Continuity Scale Chao (1988) Aims to assess patients’ perception of continuity of care 23 items 5 point Likert scales on level of true/false of statements and level of agreement with statements Study on a random sample of primary care patients demonstrated high internal reliability and better correlation with patient satisfaction compared with other continuity measures completed by providers (no further detail of this work available).
Generic Measure of Continuity of Care Haggerty (2012) Aims to assess patients’ perception of continuity of care 32 items across nine subscales:
1–3) main health care clinician (management and relationala continuity)
2) clinicians or team care (team relational, manement, informational)
3) patient’s partnership in care (support to managementa and informational)
Dichotomous, open ended and 5 point Likert scales on level of agreement with statements Pilot study on 556 patients with 2 rounds of testing to identify subscales (Cronbach’s alpha of subscales ranged from 0.66–0.93) and correlations with pre-identified indicators of continuity (0.65–0.78) [15].
Medical Care Questionnaire Harley (2009) Aims to assess patients’ experiences of continuity of care 15 items with three constructs: Communication, Coordination and preferences. 5 point Likert scales on level of agreement with statements Pilot study on 677 oncology patients with 2 rounds of testing to identify subscales (Cronbach’s alpha of subscales ranged from 0.69–0.84) and test discriminate validity (differences in ratings between 2 groups of patients with high/low preferences of seeing the same doctor).
Nijmegen Continuity Questionnaire Uijen (2011, 2014) Aims to explore patients’ perspectives of the patient-provider relationship 29 items across three subscales:
1) Personal continuity (my provider knows me)a
2) Personal continuity (my provider shows commitment)a
3) Team/cross boundary continuity
5 point Likert scale on level of agreement with statements 2 pilot studies to identify subscales (Cronbach’s alpha of subscales ranged from 0.82–0.89), confirm construct validity against other tools, and assess test-retest reliability (ICC 0.71–0.82) [20, 40].
Patient-doctor depth of relationship Ridd et al. (2011) Aims to assess patient’s perceptions of the depth of relationship with their doctor 8 items with two constructs: usual provider of care/preference for care, and relationships. A score output indicates the depth of relationship between 0 (none at all) to 32 (very strong relationship). 5 point Likert scales on level of agreement with statements Pilot study on 529 patients with 2 rounds of testing to examine face validity (via interviews), internal reliability (Cronbach’s alpha of 0.93), and test-retest reliability (ICC 0.87) [42].
Patient-doctor Relationship questionnaire-9 (PDRQ-9) Van der Feltz-Cornelis (2004) Aims to assess patient’s perceptions of the relationship with their doctor 9 items with no disparate subscales 5 point Likert scales on level of agreement with statements Pilot study on 165 patients to identify subscales (only one construct identified) [39].
Also been validated in a German-speaking population [21].
Primary Care Assessment Survey (PCAS) Safran (1996) Aims to assess patients’ experiences of primary care 57 items via 11 summary scales to measure 7 domains of care:
1) accessibility,
2) longitudinal continuitya,
3) comprehensiveness,
4) integration,
5) clinical interaction,
6) interpersonal treatmenta,
7) trusta.
5 point Likert scales on level of performance from ‘very poor’ to ‘excellent’ Testing data derived from 7204 patients during a 2-year study on primary care performance. Internal consistency of subscales was tested (Cronbach’s alpha ranged from 0.8–1.0). Item-convergence validity, item-discrimination validity, item variance, score reliability all tested.
Primary Care Assessment Tool (PCAT) The John Hopkins Primary Care Policy Center for Underserved Populations Aims to measure the extent and quality of primary care services at an individuals main source of general care 93 items via 9 subscales examining
1) Accessibilitya
2) Utilisation
3) Longitudinally of interpersonal relationships or ongoing carea
4) Coordination of services,
5) Comprehensiveness of services
6) Comprehensiveness of care received
7) Family centerednessa
8) Community orientation, and
9) Cultural experience
4 point Likert scales on level of agreement with statements Adult version tested through a pilot study with surveys and interviews to investigate reliability, validity and scoring analyses of the 9 subscales [43]. Other validation studies have been conducted in different population groups and settings.
Primary Care Evaluation Tool (PCET) Regional Office for Europe of WHO Aims to assess patients’ and providers’ perspectives of good primary health care system and service delivery 45 items covering four topics:
1) Continuitya
2) Accessibility
3) Comprehensiveness
4) Coordination
Unknown Unknown (no validation work has been published)
Therapeutic Bond Scale Saunders et al. (1989) Aims to assess patients’ perspective of the quality of therapeutic relationship with their provider 50 items across three subscales:
1) working alliancea
2) empathic resonancea
3) mutual affirmationa
5 point Likert scale on level of agreement with statements Study on 113 psychotherapy outpatients to test correlation of subscales on patients’ rating of session quality (p < 0.05 for all subscales) and outcome (p > 0.05 for all subscales) [44].
Working Alliance Inventory Short form revised (WAI-S) Hatcher & Gillaspy (2006) Aims to assess patients’ experiences with their therapist. Based on the full working alliance inventory. 12-items across three subscales:
1) Agreement on the tasks of therapy
2) Agreement on the goals of therapy
3) Development of an affective bonda
5 point Likert scale on frequency of activities from ‘never’ to ‘always’. Pilot study on 466 patients with 2 rounds of testing to examine pre-identified subscales (subscales were not able to be confirmed) [45].
N/A Al-Azri et al. (2014) Aims to assess patients’ perceptions and experiences of primary care 33 items in two sections:
1) Perception of relational continuity
2) Experience/application of relational continuity
3 point Likert scale on level of agreement with statements Pilot study on 50 patients to test suitability of tool (no further detail of this work available) [22]
N/A Hansen (2016) Aims to explore how women with chronic fatigue experience GP care 3 items exploring experiences in consultations 4 point Likert scale on frequency of activities from ‘never’ to ‘always’. Pilot study on 143 patients to test suitability of tool (no further detail of this work available) [28]
  1. aIndicates relevant subscales to this review