Primary care characteristics and population-orientated health care across Europe: an observational study

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BACKGROUND: The number of patients with chronic diseases is increasing which poses a challenge to healthcare organisations. A proactive, structured, and population-orientated approach is needed: the chronic care model (CCM) provides such a framework. AIM: To assess organisational conditions for providing structured chronic care according to the CCM across different healthcare systems. DESIGN OF STUDY: International observational study. SETTING: A stratified sample of 315 primary care practices in 10 European countries and Israel in 2008 and 2009. METHOD: Practice questionnaires and interviews. Outcome measures were mean practice scores on CCM domains per country, as a percentage of the maximum score, and the influence of practice size and urbanisation on these scores. RESULTS: Practice size showed large differences with the largest practices in Spain, England, Finland, and Israel. These countries, with a strong primary care orientation, had most physicians and staff involved per practice. The CCM domains 'clinical information systems' and 'decision support' had total practice means of 90%; other domains scored about 50%. Spain and England scored above average on almost all domains. Practice size and urbanisation had little impact. CONCLUSION: Characteristics for chronic care delivery differed for most CCM domains. The most common characteristics related to computerisation, providing a good starting point and high potential everywhere. All countries showed room for improvement. Further research should focus on relations between practice characteristics, organisational features, including health system and primary care orientation, and outcomes. Primary care seems suited for chronic care delivery; however, a stronger primary care was associated with better scores.