Integration of chronic disease prevention and management services into primary care (PR1MaC): findings from an embedded qualitative study

Abstract

BackgroundThe PR1MaC study was conducted to evaluate the integration of Chronic Disease Prevention and Management services into primary care practices and was reported effective. The aim of this study was to further explore the effects of the PR1MaC intervention on patients and their family.MethodsWe conducted a qualitative study embedded in a randomized controlled trial. The trial was implemented in eight primary health care practices in the Saguenay region, Quebec, Canada. The interdisciplinary patient-centred team-based intervention included self-management support and a motivational approach. We conducted focus groups and semi-directed individual interviews with patients, family members and healthcare professionals.ResultsPerceived positive effects can be grouped into six major themes: awareness, improved knowledge, improved motivation and empowerment, adoption of healthy behaviours, improvement of health status and improvement of quality of life. On the negative side, some participants reported lack of sustainability of newly acquired benefits in the months following the intervention.ConclusionsIntegrating chronic disease prevention and management services into primary care settings had impacts on patients and their family members. These findings are consistent with findings that were reported in the quantitative study. Further studies should address longterm sustainabilility in terms of benefits for the patients.Trial registrationClinicalTrials.gov, no.: NCT01319656.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0898-z) contains supplementary material, which is available to authorized users.

Promoting self‐efficacy in patients with chronic disease beyond traditional education: A literature review

“…The main characteristics of the sources reviewed were the implementation of an intervention to promote self‐management of the patients' disease(s) and identify behaviour effects and promotion of regimen adherence. Interventions included mobile phone applications (Baron, Hirani, & Newman, ; Hardinge et al, ), gaming (Hickman, Clochesy, Pinto, Burant, & Pignatiello, ), telehealth that included telephone or video streaming (Cameron et al, ; CottrellGalea, O'Leary, Hill, & Russell, ; Fors et al, ; Kennedy et al, ), self‐management programmes (Bratzke, ; Cutler et al, ; Devan et al, ; Fortin, Chouinard, Diallo, & Bouhali, ; Horrell et al, ; Lin, Liu, Hsu, & Tsai, ; Win et al, ), social media (van Berkel et al, ; Wilson et al, ), surveys addressing self‐efficacy (Henselmans et al, ; Koch et al, ; Roncoroni, Tucker, Wall, Wippold, & Ratchford, ; Wu et al, ) and health literacy survey (Mackey, Doody, Werner, & Fullen, ; Stellefson et al, ).…”

“…The integration of education for chronic disease management into primary care is essential and does increase outcomes for patients (Fortin et al, ). However, it is merely found to be a starting point.…”

“…In addition, Willis () posits that social connectedness and support produce greater self‐efficacy. Fortin et al () found that interventions are limited in some patients when the family is opposed to change or do not support the patient. According to Willis (), a person's self‐efficacy can directly influence behaviour change and encouragement or discouragement received from one's social support system has an impact on this.…”

“…Healthcare providers must be aware of the impact of assessment for self‐efficacy in patients affected by chronic diseases. Chronic disease prevention and self‐management education still has a significant place in primary care and continues to be the starting point for patients to manage their own disease processes and increase positive outcomes (Fortin et al, ). The need for quality patient–provider interactions and identifying the specific needs of patients is imperative (Hickman et al, ).…”

Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial

“…9 The intervention presented here is part of a scale-up of a demonstration project (PR1MaC) which reported acceptable quantitative and qualitative effectiveness in the same geographic region in 2012. 10,11 Whereas the demonstration project used a team of trained professionals managed by the research team to deliver a patient-centered intervention within practices, 12 the scaled-up intervention was delivered by professional health care professionals already in place or relocated within the FMGs. Training was provided under the control of the health care organization, which is better aligned with the existing governance structure and is more pragmatic.…”