Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities

Effective self-management is the cornerstone of chronic disease self-management. However, self-management of chronic disease in patients with comorbid dementia is particularly challenging. It is vital that clinicians, patients and carers work collaboratively to tailor self-management programs to each patient with dementia. This study aimed to identify barriers and facilitators of successful self-management in the context of cognitive impairment in order to optimise the capacity for self-management for persons with dementia (PWD). A qualitative study based on semistructured interviews was conducted in Victoria, Australia. Interviews were conducted with 12 people (employed in the ambulatory and dementia care sectors), representing six health services. Participants identified a healthcare system that is complex, not dementia friendly and not accommodating the needs of PWD who have comorbidities. Individual and systemic barriers contributed to ineffective self-management. Chronic disease support programs do not routinely undertake cognitive assessment or have guidelines for modified management approaches for those with cognitive impairment. Support needs to be long-term and requires a specialised skillset that recognises not only chronic disease management, but also the effect of cognition on self-management. Although formal guidelines are needed, care also needs to be tailored to individual cognitive abilities and deficits.

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Chronic disease management items in general practice: a population‐based study of variation in claims by claimant characteristics

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2011.tb03279.x ◽

2011 ◽

Vol 195 (4) ◽

pp. 198-202 ◽

Cited By ~ 6

Author(s):

Kirsty A Douglas ◽

Laurann E Yen ◽

Rosemary J Korda ◽

Marjan Kljakovic ◽

Nicholas J Glasgow

Keyword(s):

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Population Based ◽

Population Based Study

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Guideline Implementation in Standardized Office Workflows and Exam Types

Journal of Primary Care & Community Health ◽

10.1177/2150132719836898 ◽

2019 ◽

Vol 10 ◽

pp. 215013271983689

Author(s):

Amy Dawson ◽

Brian Henriksen ◽

Penny Cortvriend

Keyword(s):

Chronic Disease ◽

Chronic Illness ◽

Family Medicine ◽

Disease Management ◽

Qualitative Study ◽

Change Management ◽

Chronic Disease Management ◽

Medical Society ◽

Successful Implementation ◽

Card Sort

Background: Clinical practice guidelines (CPGs) in medicine are recommendations supported by systematic review of evidence to facilitate optimal patient outcomes. Primary care practices are expected to implement more than 200 CPGs, overwhelming many practices. This qualitative study elucidated the perspectives and priorities of family medicine physicians and office managers in grouping CPGs to facilitate implementation. Methods: A qualitative study was performed using individual, semistructured interviews. During the interviews the participants completed an open card-sort exercise grouping 20 CPGs. Purposive sampling was used to identify family medicine physicians and office managers practicing in medically underserved zip codes listed in the local medical society directory. Seven physicians and 6 office managers were interviewed. The interviews were transcribed and analyzed using thematic analysis and compared with the card-sort results. Results: Thematic content analysis identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for implementation: delegation, personalization, triggers, and change management. The card sort exercise revealed grouping by standardized preventive care visit, standardized rooming and discharge processes, and chronic illness. Chronic illness-based groupings and personalization of guidelines were recognized as presenting barriers to delegation of CPGs to the care team. Development of standardized preventive exams, standard rooming and discharge processes and chronic disease management were identified as promoting CPG adherence through team-based care. Standardized workflows provided opportunities for task delegation through predicable roles. Medicalization of CPG implementation relied heavily on the physician alone to remember to adhere to CPGs and inhibited task sharing by not giving office staff clear disease-based protocols to follow. Conclusions: This study identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for concomitant implementation: delegation, personalization, triggers, and change management. Successful implementation was perceived to be associated with standardized preventive exams, standard rooming and discharge processes, and chronic disease management.

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Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

10.21203/rs.3.rs-28942/v1 ◽

2020 ◽

Author(s):

Chuan De Foo ◽

Shilpa Surendran ◽

Chen Hee Tam ◽

Elaine Qiao Ying Ho ◽

David Bruce Matchar ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Qualitative Study ◽

Chronic Disease Management ◽

Primary Care Providers ◽

Great Promise ◽

Ageing Population ◽

Chronic Patients ◽

Facilitators And Barriers

Abstract Background The increasing chronic disease burden in developed countries has placed tremendous strain on tertiary healthcare infrastructure and resources. Therefore, there is an urgent need to shift chronic disease management from tertiary to primary care providers to mitigate the increase in demand for chronic care at hospitals. The organization of private general practitioners (GPs) into Primary Care Networks (PCNs) is a pragmatic move by Singapore, a developed and multi-ethnic urban city, to provide private GPs with team-based care capabilities and a platform to track care indicators for better management of chronic patients. As the PCN initiative is still in its embryonic stages, there is a void in research regarding its ability to empower private GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by private GPs in the PCN. Method: We conducted 30 semi-structured in-depth interviews with GPs enrolled in a PCN. Qualitative analysis of audio transcripts was performed to extract themes which highlighted the facilitators and barriers faced by PCN in the early stages of its development. Results Our results suggest that PCNs facilitated private GPs to more effectively manage chronic patients through 1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a “one-stop-shop”, 2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and 3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. Conclusion PCNs demonstrate great promise in empowering and motivating private GPs to manage chronic patients. However, barriers will need to be addressed to ensure the quality and comprehensiveness of PCNs in managing more chronic patients in the face of an ageing population.

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Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

10.21203/rs.3.rs-28942/v2 ◽

2020 ◽

Author(s):

Chuan De Foo ◽

Shilpa Surendran ◽

Chen Hee Tam ◽

Elaine Qiao Ying Ho ◽

David Bruce Matchar ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Qualitative Study ◽

Chronic Disease Management ◽

Primary Care Providers ◽

Great Promise ◽

Ageing Population ◽

Chronic Patients ◽

Facilitators And Barriers

Abstract Background: The increasing chronic disease burden in developed countries has placed tremendous strain on tertiary healthcare infrastructure and resources. Therefore, there is an urgent need to shift chronic disease management from tertiary to primary care providers to mitigate the increase in demand for chronic care at hospitals. The organization of private general practitioners (GPs) into Primary Care Networks (PCNs) is a pragmatic move by Singapore, a developed and multi-ethnic urban city, to provide private GPs with team-based care capabilities and a platform to track care indicators for better management of chronic patients. As the PCN initiative is still in its embryonic stages, there is a void in research regarding its ability to empower private GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by private GPs in the PCN. Method: We conducted 30 semi-structured in-depth interviews with GPs enrolled in a PCN. Qualitative analysis of audio transcripts was performed to generate themes which highlighted the facilitators and barriers faced by PCN in the early stages of its development. Results: Our results suggest that PCNs facilitated private GPs to more effectively manage chronic patients through 1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a “one-stop-shop”, 2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and 3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions.Conclusion: PCNs demonstrate great promise in empowering and motivating private GPs to manage chronic patients. However, barriers will need to be addressed to ensure the quality and comprehensiveness of PCNs in managing more chronic patients in the face of an ageing population.

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Perspectives of Chronic Disease Management Among Persons with HIV: A Qualitative Study

Patient Preference and Adherence ◽

10.2147/ppa.s287325 ◽

2021 ◽

Vol Volume 15 ◽

pp. 49-55

Author(s):

Laura Mkumba ◽

Charles Muiruri ◽

Keva Garg ◽

Melissa H Watt ◽

Nwora Lance Okeke

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Qualitative Study ◽

Chronic Disease Management

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The Linkages Between Reimbursement and Prevention: A Mixed-Methods Approach

Frontiers in Public Health ◽

10.3389/fpubh.2021.750122 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ellen Zwaagstra Salvado ◽

Hilco J. van Elten ◽

Erik M. van Raaij

Keyword(s):

Mixed Methods ◽

Chronic Disease ◽

Disease Management ◽

Healthcare Professionals ◽

Chronic Disease Management ◽

Preventive Services ◽

Population Based ◽

Rapid Review ◽

Effective Prevention ◽

Mixed Methods Approach

Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes.Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention.Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives.Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention.Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.

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