Incentivised chronic disease management and the inverse equity hypothesis: findings from a longitudinal analysis of Scottish primary care practice-level data

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

Download Full-text

A qualitative study of high-performing primary care practices during the COVID-19 pandemic

BMC Family Practice ◽

10.1186/s12875-021-01589-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Stephanie L. Albert ◽

Margaret M. Paul ◽

Ann M. Nguyen ◽

Donna R. Shelley ◽

Carolyn A. Berry

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Service Delivery ◽

Preventive Care ◽

Chronic Disease Management ◽

High Performing ◽

Care Processes ◽

Care Practices ◽

Primary Care Practices

Abstract Background Primary care practices have remained on the frontline of health care service delivery throughout the COVID-19 pandemic. The purpose of our study was to understand the early pandemic experience of primary care practices, how they adapted care processes for chronic disease management and preventive care, and the future potential of these practices’ service delivery adaptations. Methods We interviewed 44 providers and staff at 22 high-performing primary care practices located throughout the United States between March and May 2020. Interviews were transcribed and coded using a modified rapid assessment process due to the time-sensitive nature of the study. Results Practices reported employing a variety of adaptations to care during the COVID-19 pandemic including maintaining safe and socially distanced access through increased use of telehealth visits, using disease registries to identify and proactively outreach to patients, providing remote patient education, and incorporating more home-based monitoring into care. Routine screening and testing slowed considerably, resulting in concerns about delayed detection. Patients with fewer resources, lower health literacy, and older adults were the most difficult to reach and manage during this time. Conclusion Our findings indicate that primary care structures and processes developed for remote chronic disease management and preventive care are evolving rapidly. Emerging adapted care processes, most notably remote provision of care, are promising and may endure beyond the pandemic, but issues of equity must be addressed (e.g., through payment reform) to ensure vulnerable populations receive the same benefit.

Download Full-text

Missed Opportunities in Primary Care: The Importance of Identifying Depression Through Screening, Family History, and Chronic Disease Management

Journal of Psychosocial Nursing and Mental Health Services ◽

10.3928/02793695-20130109-04 ◽

2013 ◽

Vol 51 (2) ◽

pp. 27-36 ◽

Cited By ~ 4

Author(s):

Ann H. Maradiegue ◽

Fakiha Khan

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Family History ◽

Disease Management ◽

Chronic Disease Management ◽

Missed Opportunities

Download Full-text

Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-028554 ◽

2019 ◽

Vol 9 (4) ◽

pp. e028554 ◽

Cited By ~ 4

Author(s):

Marie-Pierre Gagnon ◽

Mame Awa Ndiaye ◽

Alain Larouche ◽

Guylaine Chabot ◽

Christian Chabot ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Randomised Controlled Trial ◽

Disease Management ◽

Chronic Diseases ◽

Chronic Disease Management ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Cluster Randomised ◽

Randomised Controlled

IntroductionMultimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients’ and their informal caregivers’ needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making.Methods and analysisThis project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health.Ethics and disseminationThis study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT03628963; Pre-results.

Download Full-text

Better for Ourselves and Better for Our Patients: Chronic Disease Management in Primary Care Networks

Healthcare Quarterly ◽

10.12927/hcq..18927 ◽

2007 ◽

Vol 10 (3) ◽

pp. 70-74 ◽

Cited By ~ 4

Author(s):

Barbara Every

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management

Download Full-text

Chronic Disease Management for Depression in Primary Care: A Summary of the Current Literature and Implications for Practice

The Canadian Journal of Psychiatry ◽

10.1177/070674370705200202 ◽

2007 ◽

Vol 52 (2) ◽

pp. 77-85 ◽

Cited By ~ 36

Author(s):

Nick Kates ◽

Michele Mach

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Current Literature ◽

Chronic Disease Management

Download Full-text

Building quality chronic illness care: implementation of a web-based care plan

Australian Journal of Primary Health ◽

10.1071/py19039 ◽

2020 ◽

Vol 26 (2) ◽

pp. 173

Author(s):

Shiva Vasi ◽

Jenny Advocat ◽

Akuh Adaji ◽

Grant Russell

Keyword(s):

Primary Care ◽

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

New Technologies ◽

Participant Observation ◽

Care Plan ◽

Structured Interviews ◽

Structured Approach

Structured, multidisciplinary approaches to chronic disease management (CDM) in primary care, supported by eHealth tools, show improved clinical outcomes, yet the uptake of eHealth tools remains low. The adoption of cdmNet, an eHealth tool for chronic disease management, in general practice settings, was explored. This was a qualitative case study in three general practice clinics in Melbourne, Australia. Methods included non-participant observation, reflexive note taking and semi-structured interviews with GPs, non-GP clinical staff, administrative staff and patients with chronic conditions. Data were analysed iteratively and results were reviewed at regular team meetings. Findings highlighted the significance of clinical and organisational routines in determining practice readiness for embedding innovations. In particular, clinical routines that supported a structured approach to CDM involving team-based care, allocation of resources, training and leadership were fundamental to facilitating the adoption of the eHealth tool. Non-GP roles were found to be key in developing routines that facilitated the adoption of cdmNet within a structured approach to CDM. Practice managers, administrators and clinicians should first focus on routinising processes in primary care practices that support structured and team-based processes for CDM because without these processes, new technologies will not be embedded.

Download Full-text

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

BMC Geriatrics ◽

10.1186/s12877-020-01851-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Johnny T. K. Cheung ◽

Samuel Y.S. Wong ◽

Dicken C. C. Chan ◽

Dexing Zhang ◽

Lawrence H. F. Luk ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Hong Kong ◽

Chronic Disease ◽

Disease Management ◽

Continuity Of Care ◽

Chronic Disease Management ◽

Outpatient Clinics ◽

Cross Sectional ◽

The Public

Abstract Background The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. Methods This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. Results A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73). Conclusions While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Download Full-text