scholarly journals Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

2021 ◽  
Vol 18 (6) ◽  
pp. 2926
Author(s):  
Chuan De Foo ◽  
Shilpa Surendran ◽  
Geronimo Jimenez ◽  
John Pastor Ansah ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Early Stage ◽  
Healthcare Delivery ◽  
Stage Of Development ◽  
Facilitators And Barriers ◽  
Design Options ◽  
First Contact

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.

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

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.

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

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.

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

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046010
Author(s):  
Chuan De Foo ◽  
Shilpa Surendran ◽  
Chen Hee Tam ◽  
Elaine Ho ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Qualitative Study ◽  
Chronic Conditions ◽  
Chronic Disease Management ◽  
Primary Care Providers ◽  
Great Promise ◽  
Ageing Population ◽  
Facilitators And Barriers

ObjectiveThe increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN.DesignWe conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved.SettingSingapore.ResultsOur results suggest that PCNs facilitated GPs to more effectively manage 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.ConclusionPCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population.

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

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 Objective: The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. Therefore, the Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As the PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by GPs enrolled in the PCN. Design: We conducted 30 semi-structured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved. Setting: Singapore Results: Our results suggest that PCNs facilitated 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 enrolled GPs to manage chronic patients. However, barriers will need to be addressed to ensure the viability of PCNs in managing more chronic patients in the face of an ageing population.

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

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.

scholarly journals 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 ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028554 ◽  
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.

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