Secondary Prevention in Patients with Coronary Heart Diseases: What Factors Are Associated with Health Status in Usual Primary Care ?

Dominik Ose, Justine Rochon, Stephen Campbell, Michel Wensing, Jan Van Lieshout, Lorenz Uhlmann, Tobias Freund, Joachim Szécsényi, Sabine Ludt

Research output: Contribution to journalArticle

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Abstract

Background: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL) is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL. However, these are often results of complex interventions. Evidence on aspects concerning usual primary care that actually have an impact on HRQoL remains scarce. Therefore, this observational study aimed to identify factors which are associated with HRQoL in usual primary care at practice and patient-level. Methods: This observational study was conducted in eight European countries. We were able to match data from survey instruments for 3505 patients with coronary heart disease (CHD) in 228 practices. A multilevel analysis was performed to identify associations of EQ-5D scores at patient and practice-level. Results: After dropping patients with missing information, our cohort consisted of 2656 patients. In this sample, 30.5% were female and the mean age was 67.5 years (SD 10.1). The final model included a total set of 14 potential explanatory variables. At practice-level no variable was associated with EQ-5D. At patient-level, lower education (r = -0.0381, p < 0.0001), female gender (r = -0.0543, p < 0.0001) and a higher number of other conditions (r = -0.0340, p < 0.0001), had a strong negative effect on HRQoL. Strong positive associations with HRQoL were found for a good medication adherence (Morisky) (r = 0.0195, p < 0.0001) and more positive evaluations of physicians' clinical behavior (r = 0.0282, p = 0.002). In terms of HRQoL no differences between single-handed and group practices exist. Conclusion: The results of our study suggest that a better patient-physician relationship rather than organization of CHD care is associated with higher HRQOL in the primary care setting. The results may imply that interventions to improve HRQoL require a strong patient-centered approach
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalPLoS One
Volume7
Issue number12
DOIs
Publication statusPublished - 2012
Externally publishedYes

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Secondary Prevention
health status
Health Status
Coronary Disease
quality of life
Primary Health Care
Quality of Life
Health
observational studies
Observational Studies
physicians
Multilevel Analysis
Physician-Patient Relations
Patient-Centered Care
Group Practice
Medication Adherence
coronary disease
patient care
Education
education

Cite this

Ose, Dominik ; Rochon, Justine ; Campbell, Stephen ; Wensing, Michel ; Van Lieshout, Jan ; Uhlmann, Lorenz ; Freund, Tobias ; Szécsényi, Joachim ; Ludt, Sabine. / Secondary Prevention in Patients with Coronary Heart Diseases: What Factors Are Associated with Health Status in Usual Primary Care ?. In: PLoS One. 2012 ; Vol. 7, No. 12. pp. 1-10.
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title = "Secondary Prevention in Patients with Coronary Heart Diseases: What Factors Are Associated with Health Status in Usual Primary Care ?",
abstract = "Background: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL) is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL. However, these are often results of complex interventions. Evidence on aspects concerning usual primary care that actually have an impact on HRQoL remains scarce. Therefore, this observational study aimed to identify factors which are associated with HRQoL in usual primary care at practice and patient-level. Methods: This observational study was conducted in eight European countries. We were able to match data from survey instruments for 3505 patients with coronary heart disease (CHD) in 228 practices. A multilevel analysis was performed to identify associations of EQ-5D scores at patient and practice-level. Results: After dropping patients with missing information, our cohort consisted of 2656 patients. In this sample, 30.5{\%} were female and the mean age was 67.5 years (SD 10.1). The final model included a total set of 14 potential explanatory variables. At practice-level no variable was associated with EQ-5D. At patient-level, lower education (r = -0.0381, p < 0.0001), female gender (r = -0.0543, p < 0.0001) and a higher number of other conditions (r = -0.0340, p < 0.0001), had a strong negative effect on HRQoL. Strong positive associations with HRQoL were found for a good medication adherence (Morisky) (r = 0.0195, p < 0.0001) and more positive evaluations of physicians' clinical behavior (r = 0.0282, p = 0.002). In terms of HRQoL no differences between single-handed and group practices exist. Conclusion: The results of our study suggest that a better patient-physician relationship rather than organization of CHD care is associated with higher HRQOL in the primary care setting. The results may imply that interventions to improve HRQoL require a strong patient-centered approach",
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Ose, D, Rochon, J, Campbell, S, Wensing, M, Van Lieshout, J, Uhlmann, L, Freund, T, Szécsényi, J & Ludt, S 2012, 'Secondary Prevention in Patients with Coronary Heart Diseases: What Factors Are Associated with Health Status in Usual Primary Care ?', PLoS One, vol. 7, no. 12, pp. 1-10. https://doi.org/10.1371/journal.pone.0051726

Secondary Prevention in Patients with Coronary Heart Diseases: What Factors Are Associated with Health Status in Usual Primary Care ? / Ose, Dominik; Rochon, Justine; Campbell, Stephen; Wensing, Michel; Van Lieshout, Jan; Uhlmann, Lorenz; Freund, Tobias; Szécsényi, Joachim; Ludt, Sabine.

In: PLoS One, Vol. 7, No. 12, 2012, p. 1-10.

Research output: Contribution to journalArticle

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T1 - Secondary Prevention in Patients with Coronary Heart Diseases: What Factors Are Associated with Health Status in Usual Primary Care ?

AU - Ose, Dominik

AU - Rochon, Justine

AU - Campbell, Stephen

AU - Wensing, Michel

AU - Van Lieshout, Jan

AU - Uhlmann, Lorenz

AU - Freund, Tobias

AU - Szécsényi, Joachim

AU - Ludt, Sabine

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AB - Background: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL) is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL. However, these are often results of complex interventions. Evidence on aspects concerning usual primary care that actually have an impact on HRQoL remains scarce. Therefore, this observational study aimed to identify factors which are associated with HRQoL in usual primary care at practice and patient-level. Methods: This observational study was conducted in eight European countries. We were able to match data from survey instruments for 3505 patients with coronary heart disease (CHD) in 228 practices. A multilevel analysis was performed to identify associations of EQ-5D scores at patient and practice-level. Results: After dropping patients with missing information, our cohort consisted of 2656 patients. In this sample, 30.5% were female and the mean age was 67.5 years (SD 10.1). The final model included a total set of 14 potential explanatory variables. At practice-level no variable was associated with EQ-5D. At patient-level, lower education (r = -0.0381, p < 0.0001), female gender (r = -0.0543, p < 0.0001) and a higher number of other conditions (r = -0.0340, p < 0.0001), had a strong negative effect on HRQoL. Strong positive associations with HRQoL were found for a good medication adherence (Morisky) (r = 0.0195, p < 0.0001) and more positive evaluations of physicians' clinical behavior (r = 0.0282, p = 0.002). In terms of HRQoL no differences between single-handed and group practices exist. Conclusion: The results of our study suggest that a better patient-physician relationship rather than organization of CHD care is associated with higher HRQOL in the primary care setting. The results may imply that interventions to improve HRQoL require a strong patient-centered approach

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