Establishing the validity of English GP Patient Survey items evaluating out-of-hours care.
A 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users' experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on the validity of these GPPS items.



Establish the construct and concurrent validity of GPPS items evaluating service users' experience of GP out-of-hours care.



Cross-sectional postal survey of service users (n=1396) of six English out-of-hours providers. Participants reported on four GPPS items evaluating out-of-hours care (three items modified following cognitive interviews with service users), and 14 evaluative items from the Out-of-hours Patient Questionnaire (OPQ). Construct validity was assessed through correlations between any reliable (Cochran's α>0.7) scales, as suggested by a principal component analysis of the modified GPPS items, with the 'entry access' (four items) and 'consultation satisfaction' (10 items) OPQ subscales. Concurrent validity was determined by investigating whether each modified GPPS item was associated with thematically related items from the OPQ using linear regressions.



The modified GPPS item-set formed a single scale (α=0.77), which summarised the two-component structure of the OPQ moderately well; explaining 39.7% of variation in the 'entry access' scores (r=0.63) and 44.0% of variation in the 'consultation satisfaction' scores (r=0.66), demonstrating acceptable construct validity. Concurrent validity was verified as each modified GPPS item was highly associated with a distinct set of related items from the OPQ.



Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users' overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives.
Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
Luke T A
LT
Mounce
Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
Heather E
0000-0002-9684-8182
HE
Barry
Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
Raffaele
R
Calitri
Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
William E
WE
Henley
Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
John
J
Campbell
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
Martin
M
Roland
Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK.
Suzanne
S
Richards
D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D006113:United Kingdom
Patient satisfaction; Primary care; Quality improvement; Surveys