Open Access Highly Accessed Research article

Structured chronic primary care and health-related quality of life in chronic heart failure

Marije Bosch1*, Trudy van der Weijden2, Richard Grol12, Henk Schers3, Reinier Akkermans1, Louis Niessen45 and Michel Wensing1

Author Affiliations

1 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

2 Scientific Institute for Quality of Healthcare/Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, The Netherlands

3 Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

4 Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, USA

5 School of Medicine, Policy and Practice, University of East Anglia, Norwich, UK

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BMC Health Services Research 2009, 9:104  doi:10.1186/1472-6963-9-104

Published: 19 June 2009



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.


Cross-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.


There 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).


HRQOL and treatment quality in CHF patients were not consistently associated with characteristics of structured care in primary care practices.