Overcoming challenges of implementing chronic care model in diabetes management: An action research approach

Abstract

Background: Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic. Methods: This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city – Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected. Results: The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes ( P value < 0.05). Conclusions: Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses’ capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses’ knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.

Applications of a Chronic Care Model for Self-Management of Type 2 Diabetes: A Qualitative Analysis

“…The literature suggests that the successful implementation of the CCM provides health professionals an effective framework for supporting diabetes self-management [ 27 ]. In line with previous studies [ 28 , 29 , 30 , 31 ], our findings showed that the self-management and delivery system design components of CCM are promising in diabetes management in the context of primary healthcare of Pakistan.…”

The components of diabetes educator's competence in diabetes self-management education in Iran

“…Regarding that the main focus in codification necessary competencies to manage diabetes is making a structure to provide minimum needed knowledge, skills and capabilities in practice in every levels of diabetes wide cares. [ 9 ] Many studies also emphasized lack of knowledge and widespread and serious lack of knowledge of educators about methods and techniques of education and care according to the needs of patients[ 8 10 11 12 ]…”

<p>Impact of Diabetes Continuing Education on Primary Healthcare Physicians’ Knowledge, Attitudes, and Practices</p>

“… 7 , 8 Early diagnosis, prompt clinical care, and patient counselling and empowerment through education are the most crucial steps in DM management because they help lower the risk of DM-related complications and help affected individuals to sustain good quality of life. 9 , 10 Easy access to primary healthcare settings that deliver cost-effective interventions for individuals with DM can improve their outcomes. These interventions include a combination of diet, physical activity, medication; and regular screening for complications, which aims to first achieve adequate control of blood glucose and subsequently prevent further complications.…”