The sustained ability of practices to “offer more” by incorporating aspects associated with DMPs into regular practice and by expanding activities beyond the care setting and into the community is important

in this regard as is the focus on patient-led communication. The study has several limitations. First and most importantly, this study did not include control groups corresponding to all the different patient groups. Although we found that physical quality of life declined over the 1-year period, we do not know whether this reduction Ion Channel Ligand Library mw was smaller compared with chronically ill patients not enrolled in DMPs. Worsening of the disease, poor medication adherence or an unhealthy diet may also explain declines

in quality of life. Ku-0059436 Future research should investigate the role of other health behaviors. Secondly, we included only patients’ and project managers’ reported perceptions, and did not report the effects of DMP implementation on patients’ objective health outcomes. Thirdly, respondents who completed questionnaires at T0 and T1 were on average older and more physically active than were those who completed only one questionnaire, which may have resulted in non-response bias. Physical activity may also be higher compared to patients not responding at all, which limits generalizability of our study findings. Finally, non-response bias at T0 may have affected our findings. We did however test the final full tetracosactide model on imputed data which showed similar results. DMPs based on the CCM appear to improve

physical activity among chronically ill patients over time. Furthermore, this research showed that smoking and (changes in) physical activity were important for the physical quality of life of these patients. To improve health behavior among chronically ill patients healthcare providers are advised to: • Focus on supporting patients to make healthier lifestyle choices by listening to the needs and desires of patients, for example through motivational interviewing or regular meetings with dieticians and specialized nurses; This research was supported by a grant provided by the Netherlands Organization for Health Research and Development (ZonMw, project no. 300030201). The views expressed in the paper are those of the authors. The authors declare that they have no competing interests and confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story. The authors are thankful to all healthcare workers, patients and project managers that participated in the research.