Open Access Open Badges Research article

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

Sabine Ludt1*, Jan van Lieshout2, Stephen M Campbell13, J Rochon4, Dominik Ose1, T Freund1, Michel Wensing12 and Joachim Szecsenyi1

Author Affiliations

1 Department of General Practice and Health Services Research, University Hospital of Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany

2 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands

3 Health Sciences – Primary Care Group, University of Manchester, Williamson Building, Manchester, M13 9PL, UK

4 Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany

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BMC Health Services Research 2012, 12:221  doi:10.1186/1472-6963-12-221

Published: 27 July 2012



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.