Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy

Abstract

BackgroundMore and more countries have been implementing chronic care programs, such as the Chronic Care Model (CCM) to manage non-acute conditions of diseases in a more effective and less expensive way. Often, these programs aim to provide care for single conditions instead of the sum of diseases. This paper analyzes the satisfaction and better management of single and multiple chronic patients with the core elements of chronic care programs in Siena, Italy. In addition, the paper also considers whether the CCM introduced in Siena has any influence on satisfaction and better self-management.MethodsSurvey data from patients with single chronic (N = 500) and multiple chronic diseases (N = 454), assisted by the Local Health Authority in Siena (Tuscany, Italy), were considered for the analysis. Variables on education, monitoring system, proactivity, relational continuity, model of care (CCM versus no CCM) and patient demographics were used to detect which strategies are associated with a higher patient-reported ability to better self-manage the disease and overall patient satisfaction. Logistic and ordinary logistic models were executed on data related to patients with both single and multiple chronic diseases.ResultsThe results showed that monitoring was the sole strategy associated with overall satisfaction and better self-management for both single and multiple chronic patients. Relational continuity also showed a significant positive association with better self-management perception for both patient groups, but had a positive association with patient satisfaction only for single chronic patients. Enrolment in the CCM was not associated with both overall satisfaction and better management for the two patient groups.ConclusionsStrategies that are significantly associated with satisfaction and perception of better disease self-management were the same for both single and multiple chronic patients. The delivery of care based on the Siena CCM does not seem to make a difference in the perception of better self-management and overall satisfaction for all the patients. Other concurrent strategies implemented by the regional government in Tuscany on primary care monitoring and health promotion could partially explain why CCM does not have a significant influence.

Continuity of care is associated with satisfaction with local health care services

“…Previous studies have shown the importance of a named GP in implementing continuity of care [36]. We confirmed the findings of previous studies: continuity of care markedly improves patient satisfaction [16,22].…”

“…The disease does not decrease quality of life, which can also be a result of high-quality health care services. Experience of high-quality care improves patient satisfaction [16,22]. The impact on health care service satisfaction was smaller with chronic diseases when compared to continuity of care.…”

“…The patient's perceptions, previous experiences, and fulfilment of expectations influence health care satisfaction [7,8]. Relevant factors affecting patient satisfaction include the population's demographic characteristics, health status, and chronic illnesses [7,[9][10][11][12][13][14][15][16][17][18]. Among the Finnish population, multimorbidity is rising [19].…”

Trade union or trait d'union? Setting targets for general practitioners: A regional case study

“…In general, there is a gap between the high trust with the AFT as a form of association and integration and the difficulty to perform the role of coordinator itself as a promoter of such integration. 38,39 Results are described in Table 6.…”

“…38,40,41 For GPs incentive systems, the most commonly available data are on pharmaceutical prescribing, such as the use of generic drugs. 25 However, with the chronic care model developed in Tuscany Region, 39,41 many GPs are actively developing chronic disease registries across general practices with the expectation that this will enable them to assess variations in practice and to develop strategies to improve the management of sick patients across practices. Therefore, these type of indicators to set possible target could be a precondition in developing managerial tools in primary care that consider outcome indicators and target.…”