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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

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

BMC Health Services Research > Ausgabe 1/2012
Sabine Ludt, Jan van Lieshout, Stephen M Campbell, J Rochon, Dominik Ose, T Freund, Michel Wensing, Joachim Szecsenyi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-221) contains supplementary material, which is available to authorized users.

Authors' contributions

MW developed the overall outline of the EPA-Cardio project. SC co-coordinated the selection of performance indicators, on which the EPA-Cardio audit instrument is based. SL co-coordinated the development and pilot testing of the measures, carried out data analysis and wrote the draft and final version of this paper. JvL contributed to the development and selection of measures and the draft revisions. JR provided biometrical support and contributed to analyses. DO and TF contributed to analyses and methods. JS supervised the research reported in this paper. All authors critically assessed and approved this paper.



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.
Additional file 1: Appendix - The PACIC 5A instrument *.(PDF 178 KB)
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