Structured chronic primary care and health-related quality of life in chronic heart failure.
BACKGROUND
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.


METHODS
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.


RESULTS
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 (beta = -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 (beta = 1.0, P = .04).


CONCLUSIONS
HRQOL and treatment quality in CHF patients were not consistently associated with characteristics of structured care in primary care practices.
Bosch
Marije
M
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.bosch@iq.umcn.nl
van der Weijden
Trudy
T
Grol
Richard
R
Schers
Henk
H
Akkermans
Reinier
R
Niessen
Louis
L
Wensing
Michel
M
D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006123:Group Practice / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D009426:Netherlands; D019370:Observation; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires