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Yeoh EK, Wong MCS, Wong ELY, Yam C, Poon CM, Chung RY, Chong M, Fang Y, Wang HHX, Liang M, Cheung WWL, Chan CH, Zee B, Coats AJS. Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review. Int J Cardiol 2018; 258:279-288. [PMID: 29544944 DOI: 10.1016/j.ijcard.2017.11.057] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease. METHOD AND RESULTS This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes. We included a total of 25 eligible articles. Evidence of improvement in medical outcomes and the compliance of patients with medical treatment were reported in 18 and 14 studies, respectively. Two studies demonstrated a reduction of the medical burden in terms of health service utilization, and another two studies reported the effectiveness of the programs in reducing the risk of heart failure and other cardiovascular diseases. However, CCMs were still restricted by limited academic robustness and social constraints when they were implemented in primary care. Higher professional recognition, tighter system collaborations and increased financial support may be necessary to overcome the limitations of, and barriers to CCM implementation. CONCLUSION This review has identified the benefits of implementing CCM, and recommended suggestions for the future development of CCM.
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Affiliation(s)
- E K Yeoh
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Martin C S Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Eliza L Y Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Carrie Yam
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - C M Poon
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Roger Y Chung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Marc Chong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Yuan Fang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, PR China; General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Miaoyin Liang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Wilson W L Cheung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Chun Hei Chan
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Benny Zee
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Simão CCAL, Costa MB, Colugnati FAB, de Paula EA, Vanelli CP, de Paula RB. Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2017; 2017:1709807. [PMID: 29129980 PMCID: PMC5654281 DOI: 10.1155/2017/1709807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 08/02/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
Background Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators. Methods In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs). Clinical and laboratory data of diabetic patients attending the PHCUs and from patients referred to a secondary health care (SHC) center were collected. Results There was a shortage of professionals in 53.8% of the PHCUs besides a high proportion of problems regarding referrals to SHC. At the PHCU, glycated hemoglobin results were available only in half of the medical records. A low rate of adequate glycemic control was also observed. An association between structure and process indicators and the outcomes analyzed was not found. Conclusion Major deficiencies were found in the structure and processes of the PHCUs, in addition to unsatisfactory diabetes care outcomes. However, no association between structure, process, and outcomes was found.
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Affiliation(s)
- Christiane Chaves Augusto Leite Simão
- Postgraduate Program in Brazilian Health, School of Medicine, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento, s/n, Bairro Dom Bosco, 36.038-330 Juiz de Fora, MG, Brazil
| | - Mônica Barros Costa
- Postgraduate Program in Brazilian Health, School of Medicine, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento, s/n, Bairro Dom Bosco, 36.038-330 Juiz de Fora, MG, Brazil
| | - Fernando Antônio Basile Colugnati
- Postgraduate Program in Brazilian Health, School of Medicine, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento, s/n, Bairro Dom Bosco, 36.038-330 Juiz de Fora, MG, Brazil
| | - Elaine Amaral de Paula
- Postgraduate Program in Brazilian Health, School of Medicine, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento, s/n, Bairro Dom Bosco, 36.038-330 Juiz de Fora, MG, Brazil
| | - Chislene Pereira Vanelli
- Postgraduate Program in Brazilian Health, School of Medicine, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento, s/n, Bairro Dom Bosco, 36.038-330 Juiz de Fora, MG, Brazil
| | - Rogério Baumgratz de Paula
- Postgraduate Program in Brazilian Health, School of Medicine, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento, s/n, Bairro Dom Bosco, 36.038-330 Juiz de Fora, MG, Brazil
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Lim KG, Rank MA, Cabanela RL, Furst JW, Rohrer JE, Liesinger J, Muller L, Wagie AE, Naessens JM. The asthma ePrompt: a novel electronic solution for chronic disease management. J Asthma 2012; 49:213-8. [PMID: 22304226 DOI: 10.3109/02770903.2012.654419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study tested the ability of an electronic prompt to promote an asthma assessment during primary care visits. METHODS We performed a prospective study of all eligible adult patients with previously diagnosed asthma in three geographically distinct ambulatory family medicine clinics within a 4-month period. The usual clinic visit process was performed at two geographically distinct control sites (n = 75 and n = 55 patients, respectively). The intervention group site (n = 64) had an electronic flag embedded in the Patient Check-in Locator field which prompted the distribution of a self-administered Asthma Management Questionnaire (AMQ) in the waiting room. The primary outcome measure was a documented asthma severity assessment. RESULTS The front desk distributed the AMQ successfully in 100% of possible opportunities and the AMQ was completed by 84% of patients. Providers in the intervention group were significantly more likely than providers in the two non-intervention groups to document asthma severity in the medical record during a non-asthma ambulatory clinic visit (63.3% vs. 18.7% vs. 3.6%; p < .001). CONCLUSION The provision of standardized asthma information triggered by an electronic prompt at the time of check-in effectively initiates an asthma assessment during the primary care visits.
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Affiliation(s)
- Kaiser G Lim
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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