title: A longitudinal study to identify the influence of quality of chronic care delivery on productive interactions between patients and (teams of) healthcare professionals within disease management programmes.
abstract: OBJECTIVE
  The chronic care model is an increasingly used approach to improve the quality of care through system changes in care delivery. While theoretically these system changes are expected to increase productive patient-professional interaction empirical evidence is lacking. This study aims to identify the influence of quality of care on productive patient-professional interaction.
  
  
  METHODS
  Longitudinal study in 18 Dutch regions.
  
  
  METHODS
  Questionnaires were sent to all 5076 patients participating in 18 Disease Management Programmes (DMPs) in 2010 (2676 (53%) respondents). One year later (T1), 4693 patients still participating in the DMPs received a questionnaire (2191 (47%) respondents) and 2 years later (in 2012; T2) 1722 patients responded (out of 4350; 40% response).
  
  
  METHODS
  DMPs
  
  
  METHODS
  Patients' perceptions of the productivity of interactions (measured as relational coordination/coproduction of care) with professionals. Patients were asked about communication dimensions (frequent, accurate, and problem-solving communication) and relationship dimensions (shared goals and mutual respect).
  
  
  RESULTS
  After controlling for background characteristics these results clearly show that quality of chronic care (T0), first-year changes in quality of chronic care (T1-T0) and second-year changes in quality of chronic care (T2-T1) predicted productive interactions between patients and professionals at T2 (all at p≤0.001). Furthermore, we found a negative relationship between lower educational level and productive interactions between patients and professionals 2 years later.
  
  
  CONCLUSIONS
  We can conclude that successfully dealing with the consequences of chronic illnesses requires proactive patients who are able to make productive decisions together with their healthcare providers. Since patients and professionals share responsibility for management of the chronic illness, they must also share control of interactions and decisions. The importance of patient-centeredness is growing and this study reports a first example of how quality of chronic care stimulates productive interactions between patients and professionals.
authors.affiliation: Department of Health Policy & Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jane Murray
authors.initials: JM
authors.lastname: Cramm
authors.affiliation: Department of Health Policy & Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Anna Petra
authors.initials: AP
authors.lastname: Nieboer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D055815:Young Adult
keywords: PRIMARY CARE