Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives

Abstract

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 4071 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.

Experiences of living with leprosy: A systematic review and qualitative evidence synthesis

“…Likewise, studies on chronic illnesses showed that the arrangement of seeing the same doctors for their patients resulted in good outcomes and improved the quality of care. [103,104] Darkening of the skin affects the patients' appearance and may influence treatment adherence. It is a known side-effect of Clofazimine, one of the primary drugs used to treat leprosy, besides rifampicin and dapsone.…”

“…Likewise, studies on chronic illnesses showed that the arrangement of seeing the same doctors for their patients resulted in good outcomes and improved the quality of care. [ 103 , 104 ]…”

A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: A cross-sectional study

“…Challenges and barriers to the implementation of primary health care strategies are being solved step by step to provide substantial guarantees for ensuring that community health workers shoulder their gatekeeper responsibility to protect public and population health as well as deepen the reform of primary health-care services. Adequate and professional medical training of CHWs could improve their working ability and con dence, and satisfy their perception on NCDs management [25,26]. On the demand side, if the health care providers' needs and preferences are not taken into account, it is probably more circuitous to achieve to universal health and improve their work competency.…”

A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: a cross-sectional study

“…Challenges and barriers to the implementation of primary health care strategies are being solved step by step to provide substantial guarantees for ensuring that community health workers shoulder their gatekeeper responsibility to protect public and population health as well as deepen the reform of primary health-care services. Adequate and professional medical training of CHWs could improve their working ability and confidence, and satisfy their perception on NCDs management [ 31 , 32 ]. On the demand side, if the health care providers’ needs and preferences are not taken into account, it is probably more circuitous to achieve to universal health and improve their work competency.…”