title: Primary care attributes, health care system hassles, and chronic illness.
abstract: BACKGROUND
  Patients with a chronic illness are likely to report difficulties in their encounters with the health care system. Although most patients with a chronic illness are managed by primary care clinicians, little is known about how the attributes of primary care might be related to health care system hassles.
  
  
  OBJECTIVE
  We sought to examine the relationship between attributes of primary care and health care system hassles among veterans with one or more chronic illnesses.
  
  
  METHODS
  This was a cross-sectional mailed survey.
  
  
  METHODS
  We included veterans with one or more chronic illnesses who were cared for in the South Texas Veteran's health care system.
  
  
  METHODS
  The Components of Primary Care Instrument was used to measure 4 attributes of primary care: accumulated knowledge of the patient by the clinician, coordination of care, communication, and preference for first contact with their primary care clinician. A 16-item health care systems hassles scale was constructed and demonstrated good face validity and reliability with a Cronbach's alpha of 0.94.
  
  
  RESULTS
  Of the 720 surveys administered by mail, 422 (59%) were returned. Patients with multiple chronic illnesses reported a higher level of hassles than patients with a single chronic illness. After controlling for patient characteristics, primary care communication and coordination of care were inversely associated with patient hassles score: as communication and coordination improved, the reported level of hassles decreased.
  
  
  CONCLUSIONS
  Effective delivery of primary care to patients with one or more chronic illnesses may be important in decreasing the level of hassles they experience as they interact with the health care delivery system.
authors.affiliation: VERDICT Health Services Research Center/South Texas Veterans Health Care System, TX 78229-4404, USA. parchman@uthscsa.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.forename: Polly Hitchcock
authors.initials: PH
authors.lastname: Noël
authors.forename: Shuko
authors.initials: S
authors.lastname: Lee
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013781:Texas; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*