Implementation of chronic illness care in German primary care practices-how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

TY - JOUR

T1 - Implementation of chronic illness care in German primary care practices-how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

AU - Petersen, Juliana J

AU - Paulitsch, Michael A

AU - Mergenthal, Karola

AU - Gensichen, Jochen

AU - Hansen, Heike

AU - Weyerer, Siegfried

AU - Riedel-Heller, Steffi G

AU - Fuchs, Angela

AU - Maier, Wolfgang

AU - Bickel, Horst

AU - König, Hans-Helmut

AU - Wiese, Birgitt

AU - van den Bussche, Hendrik

AU - Scherer, Martin

AU - Dahlhaus, Anne

AU - MultiCare Study Group

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.METHODS: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).RESULTS: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.CONCLUSIONS: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors.TRIAL REGISTRATION: Current Controlled Trials ISRCTN89818205.

AB - BACKGROUND: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.METHODS: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).RESULTS: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.CONCLUSIONS: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors.TRIAL REGISTRATION: Current Controlled Trials ISRCTN89818205.

KW - Chronic Disease

KW - Comorbidity

KW - Cross-Sectional Studies

KW - Evidence-Based Medicine

KW - Female

KW - Germany

KW - Health Services Accessibility

KW - Humans

KW - Male

KW - Middle Aged

KW - Models, Organizational

KW - Pain Measurement

KW - Primary Health Care

KW - Prospective Studies

KW - Quality of Health Care

KW - Quality of Life

KW - Questionnaires

KW - Self Efficacy

KW - Social Support

U2 - 10.1186/1472-6963-14-336

DO - 10.1186/1472-6963-14-336

M3 - SCORING: Journal article

C2 - 25098231

VL - 14

SP - 336

JO - BMC HEALTH SERV RES

JF - BMC HEALTH SERV RES

SN - 1472-6963

ER -