Primary care characteristics and population-orientated health care across Europe: an observational study

Abstract

The number of patients with chronic diseases is increasing which poses a challenge to healthcare organisations. A proactive, structured, and populationorientated approach is needed: the chronic care model (CCM) provides such a framework. AimTo assess organisational conditions for providing structured chronic care according to the CCM across different healthcare systems. Design of studyInternational observational study. Setting MethodPractice questionnaires and interviews. Outcome measures were mean practice scores on CCM domains per country, as a percentage of the maximum score, and the influence of practice size and urbanisation on these scores. ResultsPractice size showed large differences with the largest practices in Spain, England, Finland, and Israel. These countries, with a strong primary care orientation, had most physicians and staff involved per practice. The CCM domains 'clinical information systems' and 'decision support' had total practice means of 90%; other domains scored about 50%. Spain and England scored above average on almost all domains. Practice size and urbanisation had little impact. ConclusionCharacteristics for chronic care delivery differed for most CCM domains. The most common characteristics related to computerisation, providing a good starting point and high potential everywhere. All countries showed room for improvement. Further research should focus on relations between practice characteristics, organisational features, including health system and primary care orientation, and outcomes. Primary care seems suited for chronic care delivery; however, a stronger primary care was associated with better scores. Keywordscross-sectional studies; family practice; health services research; long-term care; primary health care. INTRODUCTIONAgeing populations, effective health technologies, and poor lifestyle have contributed to the increasing number of patients with chronic diseases. Comprehensive and coordinated management of chronic disease is a major challenge for healthcare systems, covering the full range of health care from prevention and early diagnosis to treatment of established disease. A proactive, structured and population-orientated approach is needed, with important implications for the organisation of health care. Two widely accepted frameworks on the organisation of chronic care and prevention are the chronic care model (CCM), 1 and the patient-centred medical home (PCMH).2 In the CCM, outcomes of disease management are seen as the result of interaction between a proactive practice team and an active patient. The CCM seeks to coordinate activities J van Lieshout, MD, GP and researcher; M Wensing, senior researcher,

Connectivity, contest and the ties of self‐management support for type 2 diabetes: a meta‐synthesis of qualitative literature

“…Although there are important differences with regard to the primary care orientation among European countries (van Lieshout et al . ), the primary healthcare sector in Europe is ‘on the move’ (Busse et al . 2010a).…”

Identifying factors associated with experiences of coronary heart disease patients receiving structured chronic care and counselling in European primary care

“…The underlying theoretical construct of the PACIC is the CCM; a patient centred care approach that is proactive, planned and includes goal setting, problem-solving and follow-up support. Therefore, positive association of patients’ perspectives with practice quality measures can be explained, as the quality indicators of practice organisation and chronic care used during this study could be related to these proactive CCM elements [6]. As patient experience is an important component of quality of care, and patient involvement is central to achieving good outcomes, future research is necessary to specify the constructs of patient assessment instruments that are required to obtain valid and reliable patient judgements of health care processes, particularly if patient experience is used within pay for performance systems [43].…”

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Evaluation of a program to strengthen general practice care for patients with chronic disease in Germany

“…Observational research showed that conditions for providing high-quality chronic care differ widely between practice organisations and between countries [6]. This German program to enhance general practice care is in many ways comparable to medical homes in the United States.…”