Open Access Highly Accessed Research article

The Patients Assessment Chronic Illness Care (PACIC) questionnaire in The Netherlands: a validation study in rural general practice

Michel Wensing1*, Jan van Lieshout1, Hans Peter Jung2, Jan Hermsen1 and Thomas Rosemann3

Author Affiliations

1 Scientific Institute for Quality in Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

2 General Practice Afferden, Afferden, The Netherlands

3 Department of General Practice, University Hospital Zürich, Zürich, Switzerland

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BMC Health Services Research 2008, 8:182  doi:10.1186/1472-6963-8-182

Published: 1 September 2008



Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care.


Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate). Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC), evaluations of general practice (Europep), enablement (PEI), and individual characteristics.


The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p < 0.004), but the effect of patient enablement on the PACIC score was negative (b = -1.13, p < 0.000).


A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended.