Structured chronic primary care and health-related quality of life in chronic heart failure
Open Access
- 19 June 2009
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Health Services Research
- Vol. 9 (1), 1-8
- https://doi.org/10.1186/1472-6963-9-104
Abstract
Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal clinical management in chronic heart failure (CHF) patients in primary care, as well as the association between optimal management and HRQOL. Cross-sectional observational study using multi-level random-coefficient analyses of a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined individual medical record data with patient and physician questionnaires. There was large variation in the levels and presence of structured care elements. A 91% of physicians indicated that next appointments for CHF patients were made immediately after visits, while 11% indicated that reminders on CHF management were periodically received in their practice. Few associations were found between the organizational characteristics and optimal treatment or HRQOL. Optimal pharmacological treatment related to better quality of life (β = -11.5, P < .0001). Also, more lifestyle advice was given in practices with an appointment system allowing contact with more than one professional during the encounter (β = 1.0, P = .04). HRQOL and treatment quality in CHF patients were not consistently associated with characteristics of structured care in primary care practices.This publication has 44 references indexed in Scilit:
- Clinical epidemiology of heart failureHeart, 2007
- Rethinking Prevention in Primary Care: Applying the Chronic Care Model to Address Health Risk BehaviorsThe Milbank Quarterly, 2007
- Long-Term Prognostic Significance of High-Sensitivity C-Reactive Protein Before and After Coronary Angioplasty in Patients With Stable Angina PectorisThe American Journal of Cardiology, 2007
- Care Quality and Implementation of the Chronic Care Model: A Quantitative StudyAnnals of Family Medicine, 2006
- Effect of Primary Health Care Orientation on Chronic Care ManagementAnnals of Family Medicine, 2006
- Clinical Practice Guidelines and Quality of Care for Older Patients With Multiple Comorbid DiseasesJama-Journal Of The American Medical Association, 2005
- Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart FailureJama-Journal Of The American Medical Association, 2004
- Improving Chronic Illness Care: Translating Evidence Into ActionHealth Affairs, 2001
- Improving the Quality of Health Care in the United Kingdom and the United States: A Framework for ChangeThe Milbank Quarterly, 2001
- Implementing a Clinical Pathway for Congestive Heart FailureQuality Management in Health Care, 1998