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The Chronic Care Model: congruency and predictors among primary care patients with osteoarthritis
  1. T Rosemann1,
  2. G Laux2,
  3. J Szecsenyi2,
  4. R Grol3
  1. 1
    University Hospital of Zürich, Department of General Practice, Zürich, Switzerland
  2. 2
    University Hospital of Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
  3. 3
    Center for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Professor T Rosemann, Department of General Practice, University Hospital Zürich, Rämistr. 100, 8091 Zürich, Switzerland; thomas.rosemann{at}


Objective: The Chronic Care Model (CCM) and the 5A approach have achieved widespread acceptance and reflect the core elements of patient-centred care in chronic diseases, including osteoarthritis (OA). The aim was to assess to what extent current care for patients with osteoarthritis accords with the CCM in Germany and to reveal possible predictors to assess whether certain patients are more likely to receive care complying with the CCM than others.

Methods: Cross-sectional observational study, addressing 1250 patients from 75 primary care practices in Germany. 1021 (81.7%) of the administered 1250 questionnaires were returned. The Patient Assessment of Chronic Illness Care (PACIC-5A) was used to assess accordance to the CCM and the 5A-approach. The impact of OA was assessed by means of the Arthritis Impact Measurement Scale (AIMS2-SF); the Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. Two stepwise multiple linear regression models with the PACIC sum score and the 5A score as dependents were performed to reveal predictors of a high accordance to the CCM and to the 5A approach, respectively.

Results: With a mean (SD) of 2.79 (0.83) in men and 2.67 (0.89) in women (p for difference = 0.89), the PACIC sum score was notably lower than in previous studies conducted in health maintenance organisation settings in the US. The PACIC score was associated with a higher educational level (β = 0.421; p = 0.008) and younger age (β = −0.319; p = 0.016); the 5A score was predicted by educational level (β = 0.344; p = 0.002), age (β = −0.386; p = 0.004) and the PHQ-9 score (β = −0.288; p = 0.005).

Conclusions: Younger and better educated patients achieve higher scores on the PACIC score, indicating that their care accords to a higher degree with the CCM. Whether this reflects differences in physician behaviour toward different patient groups or rather different demands of these patient groups cannot be concluded from the presented data. Further research is needed to confirm our results and assess possible implications for implementing the Chronic Care Model in primary care.

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  • Competing interests: None.

  • Funding: The study was financed by the German Ministry of Education and Research (BMBF), grant number 01GK0301.

  • Ethics approval: Ethics approval was obtained from the ethics committee of the University of Heidelberg.

  • Patient consent: Obtained.

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