چکیده (انگلیسی):

Background:Despite an increase in research devoted to primary care attributes, the patient benefits and educational
aspects of broad scope practice of primary care physicians(PCPs) have not been well studied, due to a lack of validated
measurement in each country. The objective of this study was to develop and validate the Scope of Practice Inventory
(SPI) to measure physicians’ scope of practice within the Japanese primary care setting.
Methods:The questionnaire was developed in seven phases: 1) item generation, 2) consensus method for necessity of
each item, 3) Delphi process for the importance of each item, 4) pilot tests to limit the number of items, 5) preliminary
cross-sectional study to examine factor structure and to validate the construct validity, 6) evaluation of internal
consistency and intra-class reliability, and 7) evaluation of external validity. To confirm the interpretability of the SPI, the
determinants of the SPI using a generalized linear model were evaluated.
Results:Among 359 items generated by a focus group, 180 reached a defined consensus on face and content
validity after the Delphi process. After deletion of itemswithKappavalueslessthan0.6,120itemswereselected
for the preliminary study. The principle component analysis using responses from 451 PCPs eliminated 52 items.
The final 68-point SPI had three subdomains: Inpatient care, 25 items; Urgent care and minor procedures, 27 items;
and Ambulatory care, 16 items. Internal consistency and test-retest reliability for total SPI and each subdomain revealed
acceptable reliability. Male sex, less years since graduation, working in a hospital, sub-urban or rural setting, having
remote experience, and having board certification as a PCP were positively associated with higher SPI.
Conclusions:We developed a self-administered68-point scale, the SPI, which had satisfactory validity and reliability.
Primary care quality and educational research using SPI are expected to contribute to comprehensive and efficient health
care systems in the future.