Abstract
BackgroundIn 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.MethodsThis 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).ResultsThe 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.ConclusionsThis 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 registrationCurrent Controlled Trials ISRCTN89818205.
Highlights
In primary care, patients with multiple chronic conditions are the rule rather than the exception
In Germany, the Patient Assessment of Chronic Illness Care’ (PACIC) has been used to evaluate disease management programs [19] that have been implemented in primary care nationwide and are aimed at promoting evidence-based chronic care that contains similar core elements to those used in the Chronic Care Model (CCM) [7]
Ludt et al, who analyzed a sample of patients with coronary heart disease receiving structured chronic care in a number of European countries, found that at the patient level, male gender, more frequent practice attendance, and fewer conditions, are associated with higher PACIC scores [21]
Summary
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 CCM supports the provision of high-quality care and emphasizes the importance of continuity of care in a strong primary care sector It aims to ensure care is planned, proactive and patient-centered, rather than reactive and focused on acute episodes, and it is designed to improve care in health systems at the community, organization, practice and patient levels. Ludt et al, who analyzed a sample of patients with coronary heart disease receiving structured chronic care in a number of European countries, found that at the patient level, male gender, more frequent practice attendance, and fewer conditions, are associated with higher PACIC scores [21]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
