The Chronic Care Model (CCM) is designed to help practices improve patient health outcomes by transforming the daily care for patients with chronic illnesses from acute and reactive to proactive, planned, and population-based through a combination of effective team care and planned interactions, self-management support, integrated decision support and patient registries (Coleman et al 2009). Published evidence suggests that practices redesigned in accord with the CCM generally improve the quality of care and the outcomes for patients with various chronic illnesses. The opinions of key stakeholders in relation to the readiness of the healthcare system to deliver effective CDM are vital to understanding on-going reforms within a complex system such as the health care (Darker et al 2012). The aim of this paper is to take an overview of the GPs’ perspectives across key criteria for effective chronic disease management and to offer an appraisal of what elements of the CCM are currently in place in Italy, considering a regional experience.
The regional project started on 2010 and it is based on principle of the CCM model: multidisciplinary teams composed by General Practitioners (GPs) with nurses, physiotherapists, dieticians, and medical specialists are implemented with specific tasks for each professionals. At LHA level, teams identified diagnostic and therapeutic pathways using international guidelines, and explicit recommendations that were compatible with the resources available were provided to the GPs. We used the results of a web based survey of GPs implemented in 2015 in an Italian Region to compare the experiences and satisfaction of those GPs involved and not involved in a CCM, performed a MONAVA and ANOVA analysis. The questionnaire was developed according to the international literature and was adapted for the Italian context.
Our case study highlights the positive impact of the CCM on the integration of professionals, especially with nurses, and on organizational integration, in terms of frequency of meeting to discuss about quality of care. Moreover, GPs involved in the CCM are more favourably disposed toward measurement and benchmarking, more satisfied with their job and with the health care system. Conversely, no significant differences were found in terms of the collaboration with specialists that remains weak.
Considering the GPs perspective and beliefs towards chronic care management strategies is is essential for good planning and monitoring of chronic disease management and for detecting organizational variables to prevent unintended consequences in term of professional barriers.
References
Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009 Jan-Feb;28(1):75-85. doi: 10.1377/hlthaff.28.1.75.
Darker C., Whiston L, O’Shea BChronic Disease Management in Ireland. Perspectives from patients and clinical stakeholders– implications and recommendations for the Irish healthcare system. 2012 Department of Public Health & Primary Care Trinity College Dublin
