Organisational models in primary health care to manage chronic conditions: A scoping review

Abstract

Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.

Evaluation of an interprofessional primary healthcare team as a new model of primary care in Quebec: a protocol for a type 2 effectiveness-implementation hybrid study

“…Interprofessional teams are increasingly being established throughout Canada and elsewhere to improve the access, continuity and quality of services provided to individuals living with complex health problems (eg, chronic diseases, mental health challenges and comorbidities) 6 10 15 34–36. A variety of models exist, characterised both by the organisation and degree of interprofessional collaboration, as well as the type of clients served 37–39…”

“…Access to this interprofessional approach is also facilitated because no fee is charged. In addition, compared with other reported primary care models,38 43 44 there is no preselection of patients, with all patients being eligible for the appropriate professional services. Our research project seeks to understand the experience of users attending a clinic based on this model to assess the relevance of this model for this population.…”

Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol

“…We will also explore opportunities for model optimisation using virtual care and technology, hub-andspoke design, primary nursing care structure, and integrated care navigation and coordination with existing community services and volunteer programmes. [109][110][111][112][113][114][115] Embedded health system research scientist co-leads of this study will help with building connections to existing opportunities for health system innovation in Ontario, including Ontario Health Teams. 116 Strong community care representation and leadership at innovation tables is essential for realising the potential of new care models such as LTlifeC.…”

A cluster-randomized study to evaluate the effectiveness and cost-effectiveness of the Assessment of Burden of Chronic Conditions (ABCC) tool in South Tyrolean primary care for patients with COPD, asthma, type 2 diabetes, and heart failure: the ABCC South Tyrol study

“…Therefore, there is an urgent need for an effective and integrated care model for managing chronic diseases [ 4 ]. This has led to the emergence of the Chronic Care Model (CCM), which has been proven to provide better health outcomes for patients and improve efficiency in healthcare systems [ 5 ].…”