scholarly journals A Chronic Care Model Program Incorporating Group Office Visits for Obesity Treatment in Primary Care

2011 ◽  
Vol 4 (4) ◽  
pp. 87-98 ◽  
Author(s):  
Andrea C Ely ◽  
Christie A Befort ◽  
Angela Banitt Duncan ◽  
Jianghua He ◽  
Cheryl Gibson ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Change ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Primary Care Providers ◽  
Obesity Treatment ◽  
Care Providers ◽  
Office Visits ◽  
Care Model ◽  
Weight Control Behaviors

Background. Obesity is a chronic disease of epidemic proportions. Primary care providers are on the front line of diagnosing and treating obesity and need better tools to deliver top-notch obesity care. Methods. A pilot randomized trial was conducted to test a chronic care model (CCM) program for obesity compared to usual care. Primary care patients, 18 years and older, with a body mass index (BMI) between 27 and 45 were enrolled. Sixteen weekly 90-minute group office visits were structured with the first 30 minutes encompassing individualized clinical assessments and the final 60 minutes containing the group-based standardized intensive lifestyle training. The primary outcome was weight change at 16 weeks. Secondary outcomes were weight change at 24 weeks, change in diet and physical activity behaviors, self-efficacy for weight control behaviors, and physiologic markers of cardiovascular risk at 16 and 24 weeks. Results. The participants (19 in the active arm and 10 in the control arm) were 49.8 ± 11.5 years old (mean ± SD), 97% women, 55% white, and 41% black. Weight change in the control arm at week 16 was 0.25+ 2.21 kg (mean + SD) and that for the active arm was -5.74 + 4.50 kg (n=16). The difference between the two arms was significant (p = 0.0002). Both the intent-to-treat analysis using the last observation carried forward approach and the analysis including completers only provided similar siginificant results. Conclusions. This study demonstrated that a CCM program incorporating group office visits was feasible and effective for obesity treatment in primary care settings.

scholarly journals Barriers and Facilitators towards an Integrated Chronic Care Model as experienced by primary care health providers

2016 ◽  
Vol 16 (6) ◽  
pp. 78 ◽  
Author(s):  
Geert Goderis ◽  
Gunther D'hanis ◽  
Gert Merckx ◽  
Wim Verhoevven ◽  
Pierre Sijbers ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Barriers And Facilitators ◽  
Health Providers ◽  
Care Model ◽  
Primary Care Health ◽  
Care Health

scholarly journals Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Shantanu Nundy ◽  
Jonathan J. Dick ◽  
Anna P. Goddu ◽  
Patrick Hogan ◽  
Chen-Yuan E. Lu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Health Plan ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Primary Care Team ◽  
Self Management ◽  
Management Support ◽  
Care Model ◽  
Team Based Care

Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation.Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time.Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral.Conclusion. Our innovative program enables the existing health system to support ade novocare management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

scholarly journals Features of the Chronic Care Model (CCM) Associated with Behavioral Counseling and Diabetes Care in Community Primary Care

2010 ◽  
Vol 23 (3) ◽  
pp. 295-305 ◽  
Author(s):  
P. A. O. Strickland ◽  
S. V. Hudson ◽  
A. Piasecki ◽  
K. Hahn ◽  
D. Cohen ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetes Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Care Model ◽  
Behavioral Counseling

scholarly journals Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review

2018 ◽  
Vol 258 ◽  
pp. 279-288 ◽  
Author(s):  
E.K. Yeoh ◽  
Martin C.S. Wong ◽  
Eliza L.Y. Wong ◽  
Carrie Yam ◽  
C.M. Poon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Care Model

The Chronic Care Model and the Transformation of Primary Care

2016 ◽  
pp. 89-96 ◽  
Author(s):  
Thomas Bodenheimer ◽  
Rachel Willard-Grace
Keyword(s):  
Primary Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Care Model

Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management

2020 ◽  
Vol 44 (3) ◽  
pp. 451
Author(s):  
Victar Hsieh ◽  
Glenn Paull ◽  
Barbara Hawkshaw
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Integrated Care ◽  
Significant Proportion ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Model ◽  
Care Project ◽  
Effective Delivery

ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.

Abstract TP389: Utilizing A Stroke Protocol to Improve Stroke Prevention Education

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Allison Wells ◽  
Lisa Bellamy ◽  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Stroke Prevention ◽  
Primary Care Providers ◽  
Care Providers ◽  
Office Visits ◽  
Prevention Education ◽  
Prevention Protocol ◽  
Primary Care Office ◽  
Stroke Education

Background: Although stroke is a preventable disease, it remains a leading cause of death and disability in the United States. Public knowledge of stroke prevention is relatively low. Stroke education is necessary to improve this knowledge deficit. Primary care providers play an important role in stroke education due to their ability to reach more patients and their ability to help manage the patient’s modifiable risk factors. The purpose of this project is twofold: to increase stroke knowledge in patients and to increase the amount of stroke education provided by the primary care provider. Methods: A stroke prevention protocol was created for primary care providers to utilize. The protocol helps the provider decide which patients benefit the most from stroke prevention education. If the patient has more than four stroke risk factors, the provider should initiate the stroke prevention protocol. The protocol assists the provider in delivering the stroke prevention education. Brochures were created for the provider to give to the patient. The goal of the project is to include five providers in Kentucky primary care offices. Each provider will complete an evaluation of the protocol after using it for a month. Results: Although the implementation is currently in progress, it is anticipated that the stroke protocol will improve stroke prevention education in the primary care office. Ultimately, practice will be changed by increasing the number of people who receive stroke prevention information by their primary care provider. Conclusion: Stroke education can be incorporated into primary care office visits to improve community awareness regarding stroke prevention. It is anticipated that the implementation of the stroke protocol will increase the amount of stroke education delivered to patients in the primary care setting. The evaluations completed by each healthcare provider are predicted to reflect an increase in the number of patients who receive stroke education. These evaluations will include the healthcare provider’s insight of the protocol which will assist in improving it for future use in primary care office visits.

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