title: The relationship between self-management abilities, quality of chronic care delivery, and wellbeing among patients with chronic obstructive pulmonary disease in The Netherlands.
abstract: BACKGROUND
  This cross-sectional study aimed to identify the relationship between quality of chronic care delivery, self-management abilities, and wellbeing among patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  The study was conducted in 2012 and included 548 (out of 1303; 42% response rate) patients with COPD enrolled in a COPD care program in the region of Noord-Kennemerland in The Netherlands. We employed a multilevel random-effects model (548 patients nested in 47 healthcare practices) to investigate the relationship between quality of chronic care delivery, self-management abilities, and patients' wellbeing. In the multilevel analyses we controlled for patients' background characteristics and health behaviors.
  
  
  RESULTS
  Multilevel analyses clearly showed a significant relationship between quality of chronic care delivery and wellbeing of patients with COPD (P ≤ 0.001). When self-management abilities were included in the equation while controlling for background characteristics, health behaviors, and quality of chronic care delivery, these abilities were found to have a strong positive relationship with patients' wellbeing (P ≤ 0.001). Low educational level, single marital status, and physical exercise were not significantly associated with wellbeing when self-management abilities were included in the equation.
  
  
  CONCLUSIONS
  Self-management abilities and the quality of chronic care delivery are important for the wellbeing of patients with COPD. Furthermore, self-management abilities acted as mediators between wellbeing and low educational level, single status, and physical exercise among these patients.
authors: Erasmus University Rotterdam, Department of Health Policy and Management (iBMG), Rotterdam, The Netherlands. cramm@bmg.eur.nl
authors: Jane Murray
authors: JM
authors: Cramm
authors: Anna Petra
authors: AP
authors: Nieboer
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards; D015438:Health Behavior; D006801:Humans; D008134:Long-Term Care / Q000523:psychology / Q000592:standards; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D010549:Personal Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000592:standards; D011788:Quality of Life; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: COPD; disease management; health behaviors; quality of care; self-management; wellbeing
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