Validity and reliability of the Turkish version of the assessment of chronic illness care (acic)

Aim: Our study has two main objectives: (1) the adaptation of the Assesment of Chronic Illness Care, Service Provider (ACIC) version into Turkish and the evaluation of the validity and reliability of the Turkish version of the scale in the family medicine units (FMU) in Turkey; (2) the identification of chronic ilness care/services in primary healthcare at the regional level and the elucidation of variables influencing the quality of chronic illness care/services in FMU. Materials and Methods: This research was conducted using two separate approaches: validity and reliability, and cross-sectional. In the validity and reliability section, a minimum of 5 participants were recruited for each item of the ACIC scale (n=169); for the cross-sectional section, accessing to all family physicians (n=126) was aimed in two central districts. The floor/ceiling effects, skewness, and kurtosis of the ACIC scale were described, internal consistency (assessed with Cronbach's Alpha), and construct validity (Confirmatory Factor Analysis, known-groups validity) was tested. Chi-square/degrees of freedom, RMSEA, SRMR, CFI, and NFI were given for CFA. Type 1 error was taken as <0.05 in all analyses. Results: In the validity and reliability section of the study, the ceiling and floor percentages of the scale were 0.0%, skewness value was 0.244 and kurtosis value was 0.138. The correlation coefficient (r) for all items is > 0.30, and when items are removed, Cronbach's Alpha values are less than the dimensional value. The internal consistency coefficients (Cronbach's Alpha) for the sub-dimensions of the ACIC scale range from 0.703 to 0.897. The degrees of freedom in the CFA were found to be 2.018, with an RMSEA of 0.078, SRMR of 0.06, CFI of 0.967, and NFI of 0.938. In the cross-sectional study, the average total population served by FMU was 3389.56 ± 536.04. On the disease management system (DMS), 38.2% of family physicians stated that they perform screening/monitoring for at least one disease (or condition). Screening and follow-up rates for issues covered by the DMS -excluding elderly screenings and follow-ups- (according to the objectives set by the Ministry of Health, minimum coverage percentages exceeding 40-50%) 135 ranged from 23.4% to 32.4% for screenings and from 9.1% to 18.9% for follow-ups. The minimum success rates for cancer screenings conducted by family physicians in their registered populations over the past year for cervical, colorectal, and breast cancers were found to be 18.9%, 25.2%, and 29.7%, respectively. When questioned about the reasons for not conducting screenings/follow-ups in their registered populations using the DMS, the most commonly cited reasons were workload (88.4%) and excess population (69.5%). The total score for the ACIC among family physicians was 3.95 ± 1.49, with scores for sub-dimensions ranging from 3.33 to 4.74. According to self-reports from FMU, while accessibility and continuity in primary healthcare services are partially adequate, coverage of community priority issues and coordination with hospitals are inadequate. The multivariate findings of this study have indicated that continuous education of healthcare professionals, implementation of the DMS and cancer screening activities, increased utilization of FMU by registered individuals, coordination among levels of services, and community-oriented service delivery contributed to an increase in the total scale score of the ACIC. Conclusion: The Turkish version of the ACIC scale can be used to evaluate chronic illness care/services in primary healtcare services. In our cross-sectional study, the quality of chronic illness care/services was found to be at a 'Limited support level - Level C', which is considerably lower compared to evaluations conducted in other countries. DMS is not utilized by 62.2% of family physicians, and in individuals applying DMS, the success rate of the application is significantly inadequate. Measures need to be taken to address the primary obstacles to dissemination of the DMS, which are excess population and workload burden on FMU centers. Transitioning from solo to group practice models might be a solution. Additionally, reducing the workload of FMU and increasing the responsibilities of non-physician primary healthcare workers, particularly regarding elderly follow-ups within the DMS, could help. Chronic disease management cannot be achieved without coordination at all levels of services. Therefore, regulatory adjustments must include integrated solutions with other levels of services. Addressing the lack of motivation, and continuous and in-service training of physicians would be beneficial.