Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focuses on strengthening primary care including training of the team to deliver healthcare based on the concept of Chronic Care Model(CCM). This study conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered to 25 primary care units and 16 hospital NCD clinics in 11 provinces (76 in total) to examine the effects of provider training and local health systems settings on patients’ perception of the chronic care quality.Methods A home-based interview with questionnaire was conducted on the patients in primary care settings. The questionnaire was adopted from the Thai version of the Patient Assessment of Chronic Illness Care (PACIC+) developed by the MacColl Institute for Healthcare Innovation. The questionnaire contains 20 items from the original PACIC, which measure different parts of the CCM, and an additional 6 items assess the 5A Model.Mixed effect models were employed to compare subscale of patient perception of the care quality between trained upgraded PCUs, upgraded PCUs, ordinary PCUs and NCD clinics. Upgraded PCUs were ordinary PCUs with the multiprofessional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input.Results Mixed effect models depicted an independent association between every PACIC subscale (as a measure of CCM) and facility type with the maximum likelihood for patients of ordinary PCU reporting high to highest scores (ORs: 1.52-1.76; p<0.05) compared to hospital NCD clinics. This is also the case for patients: seeing the same doctor on repeated visits (ORs: 1.66-1.87; p<0.05) or having phone contacts of the providers (ORs:1.42-1.63; p<0.05). Similarly, across all of the 5A model subscales, ORs for patients attending ordinary PCU responded with high to highest scores were 1.4-2.0 times compared to those for patients attending hospital NCD clinics(p<0.05). Conclusions We could not find evidence to support effectiveness of the training approach. The training failure might indicate a need to address mismatch between health workforce and workload. It also indicates a need to incorporate fidelity check into any training program for chronic care addressing the complex healthcare needs.
Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focused on strengthening primary care based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients about the health care services after the implementation. Methods We conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered with 27 primary care units and 11 hospital non-communicable diseases (NCDs) clinics in 11 provinces.The patients were interviewed using a validated questionnaire of the Patient Assessment of Chronic Illness Care. Upgraded primary care units (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect logistic models were employed to examine the association of subscales (high vs low score) of patient perception of the care quality with type of PCUs.Results Compared to hospital NCD clinics, ordinary PCUs were the best in the odds of receiving high score for every CCM subscale (ORs: 1.46-1.85; p<0.05), whereas the trained upgraded PCUs were better in terms of follow-up (ORs:1.37; p <0.05), and the upgraded PCU did not differ in all domains. According to the 5 A model subscales, patient assessment also revealed better performance of ordinary PCUs in all domains compared to hospital NCD clinics whereas upgraded PCUs and trained upgraded PCUs did so in some domains. Seeing the same doctor on repeated visits (ORs: 1.82-2.17; p<0.05) or having phone contacts with the providers (ORs:1.53-1.99; p<0.05) were found beneficial using CCM subscales and the 5A model subscales. However, patient assessment by both subscales did not demonstrate a statistically significant association across health insurance status.Conclusions The policy implementation might not satisfy the patients’ perception on quality of chronic care according to the CCM and the 5A model subscale. However, the arrangement of chronic care with patients seeing the same doctors or patients having telephone contact with healthcare providers may satisfy the patients’ perceived needs.
Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focuses on strengthening primary care including training of the team to deliver healthcare based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients on the health care services after the implementation. Methods We conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered to 27 primary care units and 11 hospital Non-communicable diseases (NCDs) clinics in 11 provinces.The patients were interviewed at home using a validated questionnaire of the Patient Assessment of Chronic Illness Care (PACIC+). It contains 20 items from the original PACIC, which measure different parts of the CCM, and an additional 6 items assess the 5A Model including assess, advise, agree, assist, and arrange subscales. Upgraded primary care unit (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect models were employed to compare subscale of patient perception of the care quality between trained upgraded PCUs, upgraded PCUs, ordinary PCUs and NCD clinics.Results There was an independent association between every PACIC subscale (as a measure of CCM) and facility type with the maximum likelihood for patients of ordinary PCU reporting high to highest scores (ORs: 1.46-1.85; p<0.05) compared to hospital NCD clinics. This is also the case for patients: seeing the same doctor on repeated visits (ORs: 1.82-2.17; p<0.05) or having phone contacts of the providers (ORs:1.53-1.99; p<0.05). Similarly, across all of the 5A model subscales, ORs for patients attending ordinary PCU responded with high to highest scores were 1.48-2.10 times compared to those for patients attending hospital NCD clinics (p<0.05). Conclusions The training and allocation of family physician approach in PCU may not satisfy the patients’ perception on quality of chronic care. Further studies might focus on other factors such as mismatch between health workforce and workload as a key factor influencing the success of the policy implementation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.