An Overview of Chronic Disease Models: A Systematic Literature Review

Abstract

Aims:The objective of our study was to examine various existing chronic disease models, their elements and their role in the management of Diabetes, Chronic Obstructive Pulmonary Disease (COPD), and Cardiovascular diseases (CVD).Methods:A literature search was performed using PubMed and CINHAL during a period of January 2003- March 2011. Following key terms were used either in single or in combination such as “Chronic Disease Model” AND “Diabetes Mellitus” OR “COPD” OR ‘CVD”.Results:A total of 23 studies were included in the final analysis. Majority of the studies were US-based. Five chronic disease models included Chronic Care Model (CCM), Improving Chronic Illness Care (ICIC), and Innovative Care for Chronic Conditions (ICCC), Stanford Model (SM) and Community based Transition Model (CBTM). CCM was the most studied model. Elements studied included delivery system design and self-management support (87%), clinical information system and decision support (57%) and health system organization (52%). Elements including center care on the patient and family (13%), patient safety (4%), community policies (4%), built integrated health care (4%) and remote patient monitoring (4%) have not been well studied. Other elements including support paradigm shift, manage political environment, align sectoral policies for health, use healthcare personnel more effectively, support patients in their communities, emphasize prevention, identify patient specific concerns related to the transition process, and health literacy between visits and treatments have also not been well studied in the existing literature.Conclusions:It was unclear to what extent the results generated is applicable to different populations and locations and therefore is an area of future research. Future studies are also needed to test chronic disease models in settings where more racially and ethnically representative patients receive chronic care. Future program development should also include information on other barriers including transportation issues, finances and lack of services.

Health literacy and health outcomes in chronic obstructive pulmonary disease

“…However, the impact on health outcomes of the communication gap between providers and health-care users is frequently neglected [1,3]. It is remarkable for example that neither the Global initiative Chronic Pulmonary disease (GOLD) [4] nor most of the proposed approaches to chronic care [5] address the impact of health literacy (HL) on the patient's management, in spite of the evidence that if patients cannot fully comprehend the messages from healthcare providers, they have are less likely to adhere to preventive measures [6], follow medical instructions and take prescriptions [2,6] and to carry out the required self-care for their chronic conditions [7]. The paradox of this disinterest is that if the patient's preparation and support to fully address their responsibilities in controlling and managing their sicknesses is insufficient, the chances of failure of otherwise effective therapies are greatly increased [8e10].…”

Untitled

“…The established Chronic Care Model [4] describes 6 components necessary for effective management. One component involves providing self-management support for patients [5], a broad concept that encompasses a variety of mechanisms to help patients perform the day-to-day tasks of managing their chronic illness [5]. …”

Health system redesign: Changing thoughts, values, and behaviours for the co‐production of a safety culture

“…Advances in technology and treatments have resulted in an ageing population with increased complex and chronic diseases . There is a need to shift service delivery models from a focus on acute and short‐term presentations to ones that cater to longer term and more complex episodes . As a result, there is a continued push for reconfiguration of services .…”