Patient- and provider-level determinants of self-assessed health and well-being among adults with chronic conditions in Slovenian primary care

Chronic diseases significantly impact patients’ quality of life and healthcare systems. In Slovenia, understanding the factors influencing self-assessed health and well-being can support more effective primary care policies. The purpose of this study was to identify patient- and provider-level factors associated with general health and well-being among Slovenian adults with chronic conditions. This cross-sectional study was conducted as part of the OECD-led PaRIS initiative. Data were collected from 2133 patients aged ≥ 45 years with at least one chronic condition and 70 primary care providers. Well-being was measured via the WHO-5 Well-Being Index; general health was self-rated. Mixed-effects models were used to assess associations between well-being (linear mixed model for a continuous outcome) and general health (logistic mixed-effects model for a binary outcome) and sociodemographic, behavioural, and provider-level variables. General health was rated as excellent, very good, or good by 62.5% of the patients. The mean well-being score was 60.9 (SD = 20.9). The key patient-level predictors of better health and well-being were higher income (medium vs. low OR = 1.64, 95% CI [1.26, 2.15]; high vs. low OR = 2.28, 95% CI [1.62, 3.21]), regular physical activity (OR = 1.98, 95% CI [1.57, 2.50]), age and BMI. The last two were nonlinearly associated with optimal well-being near a BMI of 25 and peaking at approximately 65–69 years of age. Male sex was associated only with greater well-being, whereas employment (OR = 2.41, 95% CI [1.67, 3.50]) and higher education (OR = 1.52, 95% CI [1.17, 1.97]) were only associated with better health. Among the provider-level factors, only the public health care setting was positively associated with well-being. Surprisingly, receiving written self-management instructions more often was linked to slightly lower well-being. Observed differences in wellbeing reached clinical relevance (10 points) for age, BMI, and regular physical activity (b = 10.46, 95% CI [8.48, 12.43]). Patient-level factors were strongly associated with self-assessed health and well-being among patients with chronic conditions, whereas provider-level organisational features showed limited associations. Care in public health care settings was associated with higher well-being. These findings support the need for age- and BMI-sensitive interventions, behaviour-focused care, and socially equitable policies in chronic disease management.