title: Primary care characteristics and population-orientated health care across Europe: an observational study.
abstract: BACKGROUND
  The number of patients with chronic diseases is increasing which poses a challenge to healthcare organisations. A proactive, structured, and population-orientated approach is needed: the chronic care model (CCM) provides such a framework.
  
  
  OBJECTIVE
  To assess organisational conditions for providing structured chronic care according to the CCM across different healthcare systems.
  
  
  METHODS
  International observational study.
  
  
  METHODS
  A stratified sample of 315 primary care practices in 10 European countries and Israel in 2008 and 2009.
  
  
  METHODS
  Practice questionnaires and interviews. Outcome measures were mean practice scores on CCM domains per country, as a percentage of the maximum score, and the influence of practice size and urbanisation on these scores.
  
  
  RESULTS
  Practice size showed large differences with the largest practices in Spain, England, Finland, and Israel. These countries, with a strong primary care orientation, had most physicians and staff involved per practice. The CCM domains 'clinical information systems' and 'decision support' had total practice means of 90%; other domains scored about 50%. Spain and England scored above average on almost all domains. Practice size and urbanisation had little impact.
  
  
  CONCLUSIONS
  Characteristics for chronic care delivery differed for most CCM domains. The most common characteristics related to computerisation, providing a good starting point and high potential everywhere. All countries showed room for improvement. Further research should focus on relations between practice characteristics, organisational features, including health system and primary care orientation, and outcomes. Primary care seems suited for chronic care delivery; however, a stronger primary care was associated with better scores.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. j.vanlieshout@iq.umcn.nl
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Margalith
authors.initials: M
authors.lastname: Goldfracht
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Sabine
authors.initials: S
authors.lastname: Ludt
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D058006:General Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008134:Long-Term Care