Evaluating the integration of chronic disease prevention and management services into primary health care

Abstract

BackgroundThe increasing number of patients with chronic diseases represents a challenge for health care systems. The Chronic Care Model suggests a multi-component remodelling of chronic disease services to improve patient outcomes. To meet the complex and ongoing needs of patients, chronic disease prevention and management (CDPM) has been advocated as a key feature of primary care producing better outcomes, greater effectiveness and improved access to services compared to other sectors. The objective of this study is to evaluate the adaptation and implementation of an intervention involving the integration of chronic disease prevention and management (CDPM) services into primary health care.Methods/DesignThe implementation of the intervention will be evaluated using descriptive qualitative methods to collect data from various stakeholders (decision-makers, primary care professionals, CDPM professionals and patients) before, during and after the implementation. The evaluation of the effects will be based on a combination of experimental designs: a randomized trial using a delayed intervention arm (n = 326), a before-and-after design with repeated measures (n = 163), and a quasi-experimental design using a comparative cohort (n = 326). This evaluation will utilize self-report questionnaires measuring self-efficacy, empowerment, comorbidity, health behaviour, functional health status, quality of life, psychological well-being, patient characteristics and co-interventions. The study will take place in eight primary care practices of the Saguenay region of Quebec (Canada). To be included, patients will have to be referred by their primary care provider and present at least one of the following conditions (or their risk factors): diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, asthma. Patients presenting serious cognitive problems will be excluded.DiscussionIn the short-term, improved patient self-efficacy and empowerment are expected. In the mid-term, we expect to observe an improvement in health behaviour, functional health status, quality of life and psychological well-being. At the organizational level, the project should lead to coordinated service delivery, improved patient follow-up mechanisms and enhanced interprofessional collaboration. Integration of CDPM services at the point of care in primary care practices is a promising innovation in care delivery that needs to be thoroughly evaluated.Trial registrationClinicalTrials.gov Identifier: NCT01319656

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

“…We hypothesized that patients receiving the intervention would report better self-management, empowerment and self-efficacy and would show reduced health-risk behaviours. 27 …”

Predictive Factors of Effects of an Interdisciplinary Chronic Disease Prevention and Management Intervention in Primary Healthcare: A Correlational Analysis

“…This study presents the secondary analysis of a pragmatic randomized controlled trial that examined the effects of an interdisciplinary CDPM intervention integrated into PHC practices: the PR1MaC project [18]. The current analysis follows a predictive correlational design with the goal to highlight the predictive factors of success of this CDPM intervention.…”

“…Intervention variables retained were: intervention duration, number of primary healthcare professionals involved, primary healthcare professionals working in consensus and number of risk factors. Details on the instruments used are available elsewhere [18] (Supplementary table).…”

“…Patients were recruited from eight primary healthcare practices in the Saguenay-Lac-St-Jean region (Québec, Canada) [18]. Participants between 18 and 75 years old presenting at least one CD (diabetes, asthma, COPD, cardiovascular diseases) or CD risk factor (physical inactivity, obesity, unhealthy eating habits, smoking, glucose intolerance, metabolic syndrome) were identified by their primary healthcare provider.…”

“…The intervention lasted 3 months and involved at least three individual interviews with CDPM practitioners, consisting of nurse coordinators, physical activity therapists, nutritionists, respiratory therapists and smoking cessation specialists [18].…”