Table 1
Characteristics of the total respondents and the respondents who visited at least two physicians.
| CHARACTERISTICS | TOTAL RESPONDENTS | RESPONDENTS WHO VISITED AT LEAST TWO PHYSICIANS | P VALUE | ||
|---|---|---|---|---|---|
| N = 2144 | N = 1730 | ||||
| Basic characteristics | |||||
| Sex (N, %) | 0.817 | ||||
| Male | 1064 | 49.63 | 865 | 50 | |
| Female | 1080 | 50.37 | 865 | 50 | |
| Age (Mean, SD) | 71.61 | 7.75 | 71.41 | 7.60 | |
| Age groups (N, %) | 0.673 | ||||
| 60–69 | 1059 | 49.39 | 872 | 50.4 | |
| 70–79 | 711 | 33.16 | 574 | 33.18 | |
| 80+ | 374 | 17.44 | 284 | 16.42 | |
| Individual income groups (N, %) | 0.991 | ||||
| <NT10,000 | 944 | 44.03 | 760 | 43.93 | |
| NT10,000–29,999 | 724 | 33.77 | 585 | 33.82 | |
| NT30,000–49,999 | 167 | 7.79 | 136 | 7.86 | |
| NT 50,000+ | 206 | 9.61 | 172 | 9.94 | |
| Missing | 103 | 4.8 | 77 | 4.45 | |
| Level of education (N, %) | 0.790 | ||||
| Illiterate/no formal education | 243 | 11.33 | 188 | 10.87 | |
| Primary school | 846 | 39.46 | 665 | 38.44 | |
| Junior high/senior high school | 704 | 32.84 | 577 | 33.35 | |
| College/university | 350 | 16.32 | 299 | 17.28 | |
| Missing | 1 | 0.05 | 1 | 0.06 | |
| Location of residence (N, %) | 0.863 | ||||
| Rural area | 434 | 20.24 | 354 | 20.46 | |
| Urban | 1708 | 79.66 | 1374 | 79.42 | |
| Missing | 2 | 0.09 | 2 | 0.12 | |
| Health status | |||||
| Perceived health status (N, %) | 0.218 | ||||
| Very good | 204 | 9.51 | 135 | 7.8 | |
| Good | 783 | 36.52 | 608 | 35.14 | |
| Fair | 665 | 31.02 | 554 | 32.02 | |
| Poor | 403 | 18.8 | 352 | 20.35 | |
| Very poor | 86 | 4.01 | 78 | 4.51 | |
| Missing | 3 | 0.14 | 3 | 0.17 | |
| Number of chronic conditions (Mean, SD) | 1.41 | 1.33 | 1.51 | 1.35 | |
| Number of chronic conditions (N, %) | 0.077 | ||||
| 0 | 646 | 30.13 | 471 | 27.23 | |
| 1 | 628 | 29.29 | 502 | 29.02 | |
| 2+ | 870 | 40.58 | 757 | 43.76 | |
| Specific chronic condition (N, %) | |||||
| Hypertension | 957 | 44.64 | 808 | 46.71 | 0.199 |
| Hyperlipidemia | 506 | 23.6 | 426 | 24.62 | 0.459 |
| Diabetes mellitus | 508 | 23.69 | 417 | 24.1 | 0.766 |
| Heart disease | 357 | 16.65 | 314 | 18.15 | 0.220 |
| Cerebrovascular disease | 86 | 4.01 | 74 | 4.28 | 0.679 |
| Renal disease | 140 | 6.53 | 131 | 7.57 | 0.206 |
| Lung disease | 109 | 5.08 | 94 | 5.43 | 0.627 |
| Liver disease | 84 | 3.92 | 75 | 4.34 | 0.515 |
| Peptic ulcer | 166 | 7.74 | 160 | 9.25 | 0.093 |
| Malignancy | 120 | 5.6 | 112 | 6.47 | 0.253 |
| Others | 393 | 18.33 | 358 | 20.69 | 0.240 |
Table 2
The COCCCA core items: Descriptive results, internal consistency and PCA results (N = 1523).
| DIMENSION/CORE ITEMS | DESCRIPTIVE ANALYSIS | INTERNAL CONSISTENCY | FACTOR LOADING FROM PCA ANALYSIS | ||||||
|---|---|---|---|---|---|---|---|---|---|
| MEAN | SD | ITEM-TOTAL CORRELATION | CRONBACH’S ALPHA | FACTOR 1 | FACTOR 2 | FACTOR 3 | FACTOR 4 | FACTOR 5 | |
| Care continuity | |||||||||
| Longitudinal relationship between patient and doctor | 0.92 | ||||||||
| How long have you been receiving health care at the most frequently visited place? | 4.39 | 1.19 | 0.86 | 0.07 | –0.03 | 0.05 | 0.04 | 0.88 | |
| How long have you been seeing the most frequently visited doctor? | 3.76 | 1.62 | 0.93 | 0.18 | –0.03 | 0.09 | 0.00 | 0.84 | |
| Information sharing between patient and doctor | 0.83 | ||||||||
| Does this doctor clearly understand your health needs? | 4.54 | 0.85 | 0.58 | 0.18 | –0.01 | 0.56 | –0.07 | 0.35 | |
| Does this doctor clearly explain your conditions or diagnosis to you? | 4.38 | 1.06 | 0.70 | 0.26 | 0.04 | 0.66 | 0.02 | 0.23 | |
| Does this doctor clearly explain issues regarding medication usage to you? | 3.72 | 1.56 | 0.79 | 0.13 | 0.07 | 0.75 | 0.14 | –0.07 | |
| Does this doctor teach you how to take care of your medical conditions or treatment problems after you go home? | 3.66 | 1.51 | 0.77 | 0.13 | 0.03 | 0.74 | 0.12 | –0.06 | |
| Interpersonal relationship between patient and doctor | 0.89 | ||||||||
| Does this doctor show a friendly attitude during the visits? | 4.45 | 0.67 | 0.73 | 0.65 | 0.05 | 0.26 | 0.03 | 0.11 | |
| Do you trust the professional competence of this doctor? | 4.35 | 0.64 | 0.81 | 0.81 | 0.04 | 0.12 | 0.08 | 0.12 | |
| Does this doctor care about you? | 4.15 | 0.74 | 0.82 | 0.79 | 0.09 | 0.13 | 0.14 | 0.04 | |
| Does this doctor make the best decision for your health care? | 4.18 | 0.68 | 0.79 | 0.78 | 0.07 | 0.16 | 0.11 | 0.08 | |
| Care coordination | |||||||||
| Information transfer among doctors | 0.85 | ||||||||
| Do you actively tell this doctor about other physician visits you have elsewhere? | 2.66 | 1.71 | 0.80 | 0.05 | 0.04 | 0.04 | 0.78 | –0.01 | |
| Does this doctor actively ask you about other physician visits you have elsewhere? | 1.83 | 1.35 | 0.76 | 0.11 | 0.18 | 0.10 | 0.75 | –0.04 | |
| Does this doctor know the situation of other physician visits you have elsewhere? | 2.68 | 1.45 | 0.75 | 0.13 | 0.14 | 0.06 | 0.72 | 0.08 | |
| Communication/cooperation among doctors | 0.89 | ||||||||
| Does this doctor communicate with other doctors about your care? | 1.36 | 0.97 | 0.87 | 0.06 | 0.83 | 0.10 | 0.15 | –0.04 | |
| Does this doctor tell you that he/she has discussed your medical conditions with other doctors? | 1.25 | 0.83 | 0.86 | 0.12 | 0.85 | 0.02 | 0.11 | –0.05 | |
| Does this doctor work together with other doctors about your care? | 1.20 | 0.75 | 0.75 | 0.04 | 0.76 | –0.01 | 0.10 | 0.02 | |
[i] COCCCA, Combined Outpatient Care Continuity and Coordination Assessment; PCA, principal component analysis; SD, standard deviation.
Figure 1
Confirmatory factor analysis of care continuity and care coordination.
Table 3
Relationship between COCCCA items and the corresponding criterion-related measures.
| DIMENSION/CORE ITEMS | HAVING A USUAL DOCTOR | PERCEIVED LACK OF CARE COORDINATION | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| NO (N = 312) | YES (N = 1211) | P VALUE | NO (N = 823) | YES (N = 527) | P VALUE | |||||
| MEAN | SD | MEAN | SD | MEAN | SD | MEAN | SD | |||
| Care continuity | ||||||||||
| Total score for longitudinal relationship between patient and doctor | 4.25 | 1.83 | 9.16 | 1.49 | <0.001 | – | – | – | – | – |
| How long have you been receiving health care at the most frequently visited place? | 3.25 | 1.83 | 4.68 | 0.71 | <0.001 | – | – | – | – | – |
| How long have you been seeing the most frequently visited doctor? | 1.00 | 0.00 | 4.48 | 0.92 | <0.001 | – | – | – | – | – |
| Total score for information sharing between patient and doctor | 14.64 | 4.41 | 16.73 | 3.24 | <0.001 | – | – | – | – | – |
| Does this doctor clearly understand your health needs? | 4.07 | 1.21 | 4.66 | 0.68 | <0.001 | – | – | – | – | – |
| Does this doctor clearly explain your conditions or diagnosis to you? | 3.82 | 1.37 | 4.52 | 0.91 | <0.001 | – | – | – | – | – |
| Does this doctor clearly explain issues regarding medication usage to you? | 3.35 | 1.64 | 3.82 | 1.52 | <0.001 | – | – | – | – | – |
| Does this doctor teach you how to take care of your medical conditions or treatment problems after you go home? | 3.40 | 1.53 | 3.73 | 1.49 | 0.001 | – | – | – | – | – |
| Total score for interpersonal relationship between patient and doctor | 15.88 | 2.17 | 17.45 | 2.02 | <0.001 | – | – | – | – | – |
| Does this doctor show a friendly attitude during the visits? | 4.13 | 0.75 | 4.53 | 0.62 | <0.001 | – | – | – | – | – |
| Do you trust the professional competence of this doctor? | 4.01 | 0.66 | 4.44 | 0.60 | <0.001 | – | – | – | – | – |
| Does this doctor care about you? | 3.86 | 0.77 | 4.22 | 0.71 | <0.001 | – | – | – | – | – |
| Does this doctor make the best decision for your health care? | 3.88 | 0.70 | 4.26 | 0.65 | <0.001 | – | – | – | – | – |
| Care coordination | ||||||||||
| Total score for information transfer among doctors | – | – | – | – | – | 7.56 | 3.60 | 6.82 | 3.19 | <0.001 |
| Do you actively tell this doctor about other physician visits you have elsewhere? | – | – | – | – | – | 2.77 | 1.70 | 2.58 | 1.70 | 0.048 |
| Does this doctor actively ask you about other physician visits you have elsewhere? | – | – | – | – | – | 1.94 | 1.42 | 1.70 | 1.24 | 0.001 |
| Does this doctor know the situation of other physician visits you have elsewhere? | – | – | – | – | – | 2.84 | 1.47 | 2.54 | 1.39 | <0.001 |
| Total score for communication/cooperation among doctors | – | – | – | – | – | 3.97 | 2.33 | 3.63 | 1.84 | 0.003 |
| Does this doctor communicate with other doctors about your care? | – | – | – | – | – | 1.42 | 1.07 | 1.28 | 0.82 | 0.004 |
| Does this doctor tell you that he/she has discussed your medical conditions with other doctors? | – | – | – | – | – | 1.30 | 0.90 | 1.19 | 0.72 | 0.014 |
| Does this doctor work together with other doctors about your care? | – | – | – | – | – | 1.25 | 0.83 | 1.16 | 0.63 | 0.031 |
[i] COCCCA, Combined Outpatient Care Continuity and Coordination Assessment; PCA, principal component analysis.