Cross Cultural Epidemiology And Health Related Quality Of Life Measurement Among Primary Care Patients With Chronic Diseases

BackgroundAn epidemiological transition has taken place since the middle of the 20th century from predominantly communicable diseases to chronic diseases. Chronic disease may not be fatal, but consumes a lot of health resources and compromises the quality of life of the sufferers. There is a consensus that health-related quality of life (HRQoL) is one of the important aspects of health status. The centrality of people's point of view in monitoring HRQoL has led to the proliferation of generic or disease-specific instruments and a rapid development of theoretical literature in this field. Interest in the "international" side of HRQoL assessment is growing rapidly due to the increasingly international nature of drug trials, clinical researches and global health policies."The Ecology of Medical Care" is a broad framework for thinking about the organization of health care, medical education, and research. Based on prevalence estimates of illness and the roles of various sources of health care in the provision of medical care, the model highlights the need for comprehensive medical-information systems that span all sites of care. Patients seeking help in primary care are a special selection from the general, population. The health status for patients with chronic conditions and relevant factors should be assessed in every health care setting separately. Information on health status related to patients outside primary care can not be generalized to patients in this setting.Primary health care is a salient point of every health care system in developed or developing countries. The concept of primary health care provides a common point of reference for one basic function of health care provision even in very different settings. In some countries, general practice/family medicine has developed into a core element of health care delivery and a well-defined academic discipline. However, traditionally in theUnited States and most developed European countries, the capabilities of secondary and highly specialized medicine were the pride of these countries. Only in the last twenty years it is understood that a qualified system of primary care is necessary for an optimal and affordable use of medical resources. In developing countries, the possibility to get medical care for almost everybody was the pride in earlier stages of development, and now, reforms are planned to strengthen the system of primary care for the challenges of social development. This has resulted in a paucity of information on the distribution of morbidity in primary care of these countries. Information such as that patients with which health problems consult in primary care and which kind of health problems could be solved by primary care physicians is very important for health planning, community health service training and patients' health education.ObjectivesTo investigate HRQoL for primary care patients in Zhejiang Province, China and Germany; to estimate independent influence of each chronic disease on the HRQoL independent of the effects of demographic factors and co-morbidity; to compare HRQoL cross culturally for patients with chronic diseases; to reflect prevalence estimates of illness and HRQoL for patients consulting in primary care and further provide information for health policy research and cross cultural collaboration.Methods1.Sample size: the per group sample size was decided by the level of a two-tailed test ( =0.05), the power of the test (80%), the presumed underlying difference (5 point), the within group standard deviation (34 as referred to Hangzhou and German norms) and a non-response rate of 20%.2.Setting: In Germany, 20 general practices from the regional mailing list of the Institute of General Practice, University Hospital Schleswig-Holstein, or known from earlier research contacts, consented to take part, and were recruited to the study. In Zhejiang Province, 25 community health service centers (stations) among the list of all community health service centers (stations) in Hangzhou city and several ce...