Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

Abstract

Background The increasing chronic disease burden in developed countries has placed tremendous strain on tertiary healthcare infrastructure and resources. Therefore, there is an urgent need to shift chronic disease management from tertiary to primary care providers to mitigate the increase in demand for chronic care at hospitals. The organization of private general practitioners (GPs) into Primary Care Networks (PCNs) is a pragmatic move by Singapore, a developed and multi-ethnic urban city, to provide private GPs with team-based care capabilities and a platform to track care indicators for better management of chronic patients. As the PCN initiative is still in its embryonic stages, there is a void in research regarding its ability to empower private GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by private GPs in the PCN. Method: We conducted 30 semi-structured in-depth interviews with GPs enrolled in a PCN. Qualitative analysis of audio transcripts was performed to extract themes which highlighted the facilitators and barriers faced by PCN in the early stages of its development. Results Our results suggest that PCNs facilitated private GPs to more effectively manage chronic patients through 1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a “one-stop-shop”, 2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and 3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. Conclusion PCNs demonstrate great promise in empowering and motivating private GPs to manage chronic patients. However, barriers will need to be addressed to ensure the quality and comprehensiveness of PCNs in managing more chronic patients in the face of an ageing population.

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

“…While this analysis was limited to data collected from the previous qualitative study [44], the data were suitably rich to allow us to gain meaningful new insights. Moreover, this study's research question fitted well with that of the original study, as both studies were concerned with chronic disease management in PCNs.…”

“…A secondary qualitative analysis was performed using qualitative data obtained from an earlier study exploring the perceived barriers and facilitators experienced by private GPs enrolled in PCNs [44]. Consequently, it was considered valid to re-examine the collected data and explore how PCN manifests the "4Cs" when managing patients with chronic conditions [45].…”

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