Department of General Practice and Health Services Research, University Hospital of Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.
BMC Health Serv Res. 2012 Jul 27;12:221. doi: 10.1186/1472-6963-12-221.
Primary care for chronic illness varies across European healthcare systems. In patients suffering from coronary heart disease (CHD), factors associated with patients' experiences of receiving structured chronic care and counselling at the patient and practice level were investigated.
In an observational study comprising 140 general practices from five European countries (Austria, Germany, the Netherlands, Switzerland and the United Kingdom), 30 patients with Coronary Heart Disease (CHD) per practice were chosen at random to partake in this research. Patients were provided with a questionnaire and the Patient Assessment of Chronic Illness Care (PACIC-5A) - instrument. Practice characteristics were assessed through a practice questionnaire and face to face interviews. Data were aggregated to obtain two practice scores representing quality management and CHD care, respectively. A hierarchical multilevel analysis was performed to examine the impact of patient and practice characteristics on PACIC scores.
The final sample included 1745 CHD-patients from 131 general practices with a mean age of 67.8 (SD 9.9) years. The overall PACIC score was 2.84 (95%CI: 2.79; 2.89) and the 5A score reflecting structured lifestyle counselling was 2.75 (95% CI: 2.69; 2.79). At the patient level, male gender, more frequent practice contact and fewer related or unrelated conditions were associated with higher PACIC scores. At the practice level, performance scores reflecting quality management (p = 0.013) and CHD care (p = 0.009) were associated with improved assessment of the structured chronic care and counselling received.
Patients' perceived quality of care varies. However, good practice management and organisation of care were positively reflected in patients' assessments of receiving structured chronic illness care. This highlights the importance of integrating patient experiences into quality measurements to provide feedback to health care professionals.
欧洲各国的医疗体系在慢性病的初级保健方面存在差异。本研究旨在调查冠心病患者在患者和实践层面接受结构化慢性病护理和咨询的经历，探讨与这些经历相关的因素。
在一项包含五个欧洲国家（奥地利、德国、荷兰、瑞士和英国）的 140 家普通诊所的观察性研究中，随机选择每个诊所的 30 名冠心病患者参与本研究。患者接受问卷调查和慢性病患者评估工具（PACIC-5A）评估。通过实践问卷和面对面访谈评估实践特征。数据汇总后获得两个代表质量管理和冠心病护理的实践评分。采用分层多水平分析方法，考察患者和实践特征对 PACIC 评分的影响。
最终样本包括来自 131 家普通诊所的 1745 名冠心病患者，平均年龄为 67.8（9.9）岁。总体 PACIC 评分为 2.84（95%CI：2.79；2.89），反映结构化生活方式咨询的 5A 评分为 2.75（95%CI：2.69；2.79）。在患者层面上，男性、更频繁的就诊次数以及较少的相关或无关疾病与更高的 PACIC 评分相关。在实践层面上，反映质量管理（p=0.013）和冠心病护理（p=0.009）的绩效评分与患者对接受结构化慢性病护理和咨询的评估改善相关。
患者感知的护理质量存在差异。然而，良好的实践管理和护理组织在患者对接受结构化慢性病护理的评估中得到了积极的反映。这凸显了将患者体验纳入质量测量以向医疗保健专业人员提供反馈的重要性。
