Factors influencing the implementation of chronic care models: A systematic literature review

Abstract

BackgroundThe increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations. Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM). The implementation of complex interventions such as CCMs requires careful consideration and planning. Success depends on a number of factors at the healthcare provider, team, organisation and system levels.MethodsThe aim of this systematic review was to systematically examine the scientific literature in order to understand the facilitators and barriers to implementing CCMs within a primary healthcare setting. This review focused on both quantitative and qualitative studies which included patients with chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus, depression and HIV/AIDS) receiving care in primary healthcare settings, as well as primary healthcare providers such as doctors, nurses and administrators. Papers were limited to those published in English between 1998 and 2013.ResultsThe search returned 3492 articles. The majority of these studies were subsequently excluded based on their title or abstract because they clearly did not meet the inclusion criteria for this review. A total of 226 full text articles were obtained and a further 188 were excluded as they did not meet the criteria. Thirty eight published peer-reviewed articles were ultimately included in this review. Five primary themes emerged. In addition to ensuring appropriate resources to support implementation and sustainability, the acceptability of the intervention for both patients and healthcare providers contributed to the success of the intervention. There was also a need to prepare healthcare providers for the implementation of a CCM, and to support patients as the way in which they receive care changes.ConclusionThis systematic review demonstrated the importance of considering human factors including the influence that different stakeholders have on the success or otherwise of the implementing a CCM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0319-5) contains supplementary material, which is available to authorized users.

Effectiveness of the EMPOWER-PAR Intervention in Improving Clinical Outcomes of Type 2 Diabetes Mellitus in Primary Care: A Pragmatic Cluster Randomised Controlled Trial

“…The process of PAR allowed the primary care providers in this study to have increased autonomy to design the intervention plan based on the CCM elements and made the choice of actions within their constraints to improve their patients’ health outcomes. Successful implementation of a complex, multifaceted CCM intervention may depend not only on the provision of appropriate resources and the development of effective systems and processes, but also on the various stakeholders who will interpret and influence the implementation process [41]. Human factors, including the role of healthcare providers and their leaders who can either facilitate or impede successful implementation, should be considered [41].…”

“…Successful implementation of a complex, multifaceted CCM intervention may depend not only on the provision of appropriate resources and the development of effective systems and processes, but also on the various stakeholders who will interpret and influence the implementation process [41]. Human factors, including the role of healthcare providers and their leaders who can either facilitate or impede successful implementation, should be considered [41]. The PAR approach also allowed collegial environment to develop between facilitators and the CDM Team in this study.…”

“…This factor may have promoted better reflective practice and could have contributed towards the improved outcomes. In addition to ensuring appropriate resources, successful implementation of CCM interventions would highly depend on whether the intervention is acceptable to both patients and healthcare providers [41]. Primary care providers must be actively involved in the change process to ensure that patients are supported throughout the implementation of CCM interventions.…”

Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review

“…Moreover, healthcare providers have shown good adherence to the medical practices which were tailored and multifaceted with CCM components [30]. Nevertheless, no single component within CCM may achieve all these expected goals, indicating that adopting multiple components of CCMs is essential to enhancing quality health in primary care [10][11][12][14][15][16]19,[31][32][33][34].…”

iConnect CKD – virtual medical consulting: A web‐based chronic kidney disease, hypertension and diabetes integrated care program

“…Like telemedicine, eHealth has struggled to establish itself in routine healthcare delivery . This supports the view that human factors need to be considered when implementing complex interventions . There is a critical need to further invest in the software and its integration into existing systems.…”