Abstract
BackgroundStructured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal clinical management in chronic heart failure (CHF) patients in primary care, as well as the association between optimal management and HRQOL.MethodsCross-sectional observational study using multi-level random-coefficient analyses of a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined individual medical record data with patient and physician questionnaires.ResultsThere was large variation in the levels and presence of structured care elements. A 91% of physicians indicated that next appointments for CHF patients were made immediately after visits, while 11% indicated that reminders on CHF management were periodically received in their practice. Few associations were found between the organizational characteristics and optimal treatment or HRQOL. Optimal pharmacological treatment related to better quality of life (β = -11.5, P < .0001). Also, more lifestyle advice was given in practices with an appointment system allowing contact with more than one professional during the encounter (β = 1.0, P = .04).ConclusionHRQOL and treatment quality in CHF patients were not consistently associated with characteristics of structured care in primary care practices.
Highlights
Structured care is proposed as a lever for improving care for patients with chronic conditions
Guidelines on the management of chronic heart failure (CHF) recommend pharmacological treatment to deal with heart failure symptoms and to reduce morbidity and mortality in most patients: in particular ACE inhibitors (ACEI) or angiotensin-II receptor blockers (ARB) and β-blockers [5,6,7]
In this study we explored the extent to which structured chronic care features, derived from the Chronic Care Model, are associated with health-related quality of life (HRQOL) and optimal management in heart failure in primary care
Summary
Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal clinical management in chronic heart failure (CHF) patients in primary care, as well as the association between optimal management and HRQOL. Many CHF patients are managed in primary care, but research on organization of primary care for CHF is limited. Guidelines on the management of CHF recommend pharmacological treatment to deal with heart failure symptoms and to reduce morbidity and mortality in most patients: in particular ACE inhibitors (ACEI) or angiotensin-II receptor blockers (ARB) and β-blockers [5,6,7]. Clinical guidelines [5,6,7] incorporate principles of structured chronic care such as patient counselling on self management to promote continuity of care. Patients are to be monitored regularly with (daily) body weight measurements and are to receive lifestyle advice, such as reducing salt intake, limiting fluid intake, exercise, and resting periods
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