• Michel Wensing, Pieter Van den Hombergh, Jan Van Doremalen, Richard Grol, and Joachim Szecsenyi.
• Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. M.Wensing@kwazo.umcn.nl
• Health Policy. 2009 Jan 1; 89 (1): 124-9.

ObjectiveThis study aimed to explore the associations between chronic care organisation and physician workload in primary care.DesignSecondary analysis of observational data.Setting And ParticipantsOne hundred and forty general practices from 10 European countries.Mean Outcome MeasuresThe Chronic Care Model was used to specify measures for chronic care organisation in the practice. Practice size was operationalised as the number of yearly attending patients in the practice and physician workload as the mean number of physician working hours per 1000 yearly attending patients. Mixed linear regression analysis models were used.ResultsSome aspects of chronic care organisation seemed to be associated with physician workload. After controlling for practice size and non-physician staff, none of these effects remained significant. Physicians worked, on average, 1.29h less per week for each additional 1000 patients yearly attending the practice. Each additional 0.1 full time equivalent assistance in the practice was associated with an increase of 1.6 physician working hours per week per 1000 patients.ConclusionsPractice size rather than chronic care organisation determined physician workload. Larger practices might use physicians' time more efficiently compared to small practices, but reduced quality of care in larger practices could be an alternative interpretation of the findings.

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