title: The concordance of care for age related macular degeneration with the chronic care model: a multi-centered cross-sectional study.
abstract: OBJECTIVE
  The aim of the study was to assess the concordance of care for age related macular degeneration with the evidence-based framework for care for chronic medical conditions known as the chronic care model. Furthermore we aimed to identify factors associated with the concordance of care with the chronic care model.
  
  
  METHODS
  Multi-centered cross-sectional study. 169 patients beginning medical treatment for age related macular degeneration were recruited and analyzed. Patients completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire, reflecting accordance to the chronic care model from a patient's perspective, the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and Patient Health Questionnaire (PHQ-9). Visual acuity and chronic medical conditions were assessed. Nonparametric tests and correlation analyses were performed, also multivariable regression analysis.
  
  
  RESULTS
  The median PACIC summary score was 2.4 (interquartile range 1.75 to 3.25), the lowest PACIC subscale score was "follow-up/coordination" with a median of 1.8 (interquartile range 1.00 to 2.60). In multivariable regression analysis the presence of diabetes type 2 was strongly associated with low PACIC scores (coefficient = -0.85, p = 0.007).
  
  
  CONCLUSIONS
  Generally, care for patients with age related macular degeneration by ophthalmologists is in moderate concordance with the chronic care model. Concerning follow-up and coordination of health service, large improvements are possible. Future research should answer the question how healthcare delivery can be improved effecting relevant benefits to patients with AMD.
authors.affiliation: Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Markun
authors.affiliation: Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brändle
authors.affiliation: Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Avraham
authors.initials: A
authors.lastname: Dishy
authors.affiliation: Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland; Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Frei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008134:Long-Term Care; D008268:Macular Degeneration / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014792:Visual Acuity