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Assessing patient's experience in an integrated care context by means of health survey


Maider Mateos ,

Department of Health. Basque Government, ES
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Jose Antonio Martín,

Department of Health. Basque Government, ES
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Maite de Diego

Department of Health. Basque Government, ES
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Introduction: Integrated care is a principle of the organization of health care that seeks to improve health outcomes by integrating care processes and taking the person as the central focus of care.

The IEXPAC questionnaire (Chronic Patient Experience Evaluation Instrument) collects information about the patient's experience defined as the person's perception of the continuous interaction with the professionals and services responsible for their care as well as the results of this interaction. Although the IEXPAC questionnaire was not specifically designed to evaluate the integration of care, it measures questions closely related to it such as the productivity of the interactions and the relationship model between the patient and the system. Moreover, it has been demonstrated that patient experience is associated to patient safety and clinical effectiveness.

Between 2010 and 2016 Osakidetza (Basque Health Service) performed an integration process aiming at reducing the fragmentation of care that led to 13 integrated health organizations covering all the Basque population. In this context, the IEXPAC questionnaire was included in the Basque Health Survey 2018, a key instrument for planning and decision-making in health policies.

The objective is to measure the patient’s experience as an indicator of the quality of healthcare integration in the Basque health system.

Method: Cross-sectional survey on the state of health, its determinants, and the use and opinion of the health services in the non-institutionalized population living in the Basque Country that declared having a chronic condition and having contacted a health professional in the last 12 months. The IEXPAC global score and the continuity score at discharge were calculated. Results were obtained by sex, age and social class.

Results: Data collection was conducted between October 2017 and May 2018. 2,276 women and 1,818 men answered the questionnaire. The overall score obtained was 5.3 points out of 10 in women and 5.4 in men. The score on continuity of care after hospital discharge was 6.3 and 6.1 points in women and men, respectively.

Items referring the new ways of interaction of the patient with the system or with other patients using non-face-to-face methods were the worst rated with scores around 1.5 points out of 5. Both the questions that measure the productivity of the interactions and those regarding the self-management of the patient reached scores close to 4 out of 5.

A gradient in the overall score according to age was observed so that the patient's experience was better as the age increased. Differences in the IEXPAC score according to social class were not relevant.

Discussion: In the context of the integrated health system of the Basque Country,  patient experience measured through the IEXPAC questionnaire as part of the Health Survey, was valued at around 5.4 points out of 10. Similar results were obtained in another region of Spain in a smaller study conducted on activated patients.

Conclusions: The use of the IEXPAC questionnaire in Health Surveys allows the assessment of the patient's experience in the continuity of their care and leads to the identification of potential areas for improvement.

How to Cite: Mateos M, Martín JA, de Diego M. Assessing patient's experience in an integrated care context by means of health survey. International Journal of Integrated Care. 2019;19(4):390. DOI:
Published on 08 Aug 2019.


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