Do older patients and their family caregivers agree about the quality of chronic illness care?

Abstract

Objective: Family caregivers often accompany patients to medical visits; however, it is unclear whether caregivers rate the quality of patients' care similarly to patients. This study aimed to (1) quantify the level of agreement between patients' and caregivers' reports on the quality of patients' care and (2) determine how the level of agreement varies by caregiver and patient characteristics.

Design: Cross-sectional analysis.

Participants: Multimorbid older (aged 65 and above) adults and their family caregivers (n = 247).

Methods: Quality of care was rated separately by patients and their caregivers using the Patient Assessment of Chronic Illness Care (PACIC) instrument. The level of agreement was examined using a weighted kappa statistic (Kw).

Results: Agreement of caregivers' and patients' PACIC scores was low (Kw = 0.15). Patients taking ten or more medications per day showed less agreement with their caregivers about the quality of care than patients taking five or fewer medications (Kw = 0.03 and 0.34, respectively, P < 0.05). Caregivers who reported greater difficulty assisting patients with health care tasks had less agreement with patients about the quality of care being provided when compared with caregivers who reported no difficulty (Kw = -0.05 and 0.31, respectively, P < .05). Patient-caregiver dyads had greater agreement on objective questions than on subjective questions (Kw = 0.25 and 0.15, respectively, P > 0.05).

Conclusion: Patient-caregiver dyads following a more complex treatment plan (i.e. taking many medications) or having more difficulty following a treatment plan (i.e. having difficulty with health care tasks) had less agreement. Future qualitative research is needed to elucidate the underlying reasons patients and caregivers rate the quality of care differently.

Keywords: caregiver; primary care; quality of care.

Figure 1

This scatter plot shows median PACIC response for each patient–caregiver dyad in the sample. The data points are presented with a slight jitter (deviation from absolute value) to allow for easier viewing.

Figure 2

These histograms show the distribution of difference in median PACIC score (caregiver score–patient score) for different patient median scores. Black bars represent the number of caregiver who rated care more highly than patients (n = 102); gray bars represent caregivers who rated care the same as patients (n = 64) and white bars represent caregivers who rated care as worse than patients (n = 81). PACIC, Patient Assessment of Chronic Illness Care instrument; CG, caregiver; PT, patient.