Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

Foo, Chuan De; Surendran, Shilpa; Jiménez, Gerónimo; Ansah, John P.; Matchar, David B.; Koh, Gerald Choon Huat

doi:10.3390/ijerph18062926

Cited by 13 publications

(15 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Amid the pandemic, an expansion of such PPP models may help acute hospitals clear the backlog and build capacity for pandemic surges while vulnerable non-COVID patients with chronic conditions are safely managed closer to home. 45 At the time of writing, very few empirical studies explored the experience and impacts of the COVID-19 control measures on chronic care management. 15 This study adds to the knowledge gap by providing a detailed account of how COVID-19 affected the delivery of health care services for non-COVID patients with underlying chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

Spillover Effects of COVID-19 on Essential Chronic Care and Ways to Foster Health System Resilience to Support Vulnerable Non-COVID Patients: A Multistakeholder Study

Yoon¹,

Goh²,

Chan³

et al. 2022

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

Objectives: Little empirical research exists on how key stakeholders involved in the provision of care for chronic conditions and policy planning perceive the indirect or "spillover" effects of the COVID-19 on non-COVID patients. This study aims to explore stakeholder experiences and perspectives of the impact of COVID-19 on the provision of care for chronic conditions, evolving modalities of care, and stakeholder suggestions for improving health system resilience to prepare for future pandemics. Design: Qualitative study design.Setting and Participants: This study was conducted during and after the COVID-19 lockdown period in Singapore. We recruited a purposive sample of 51 stakeholders involved in care of non-COVID patients and/or policy planning for chronic disease management. They included health care professionals (microlevel), hospital management officers (meso-level), and government officials (macro-level). Methods: In-depth semi-structured interviews were conducted. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed. Results: Optimal provision of care for chronic diseases may be compromised through the following processes: lack of "direct" communication between colleagues on clinical cases resulting in rescheduling of patient visits; uncertainty in diagnostic decisions due to protocol revision and lab closure; and limited preparedness to handle non-COVID patients' emotional reactions. Although various digital innovations enhanced access to care, a digital divide exists due to uneven digital literacy and perceived data security risks, thereby hampering wider implementation. To build health system resilience, stakeholders suggested the need to integrate digital care into the information technology ecosystem, develop strategic public-private partnerships for chronic disease management, and give equal attention to the provision of holistic psychosocial and community support for vulnerable non-COVID patients.S.Y. and H.G. are co-first authors.

show abstract

Section: Discussionmentioning

confidence: 99%

Spillover Effects of COVID-19 on Essential Chronic Care and Ways to Foster Health System Resilience to Support Vulnerable Non-COVID Patients: A Multistakeholder Study

Yoon¹,

Goh²,

Chan³

et al. 2022

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

show abstract

“…Proposition (1) presents that ∆QALYs increases with b t (P) (the probability of having chronic diseases) at each period t. As a result, compared to waiting, patients with high risk tend to diagnose by invasive tests. This suggests that an increased risk of chronic diseases naturally increases the future reward of diagnosis and reduces the relative effect from side effects of an invasive test and subsequent treatment on patients.…”

Section: Structural Propertiesmentioning

confidence: 99%

“…Chronic diseases remain one of the major public health problems in the world, imposing a high cost burden on healthcare systems and reducing the quality of life of patients [ 1 , 2 , 3 ]. About half of all adults have one or more chronic diseases, which are responsible for 70% of deaths in the United States and account for more than 85% of total healthcare expenses [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Policies Optimization for Chronic Diseases Based on POMDP Model

Zhang

Wang

2022

Healthcare

View full text Add to dashboard Cite

During the process of disease diagnosis, overdiagnosis can lead to potential health loss and unnecessary anxiety for patients as well as increased medical costs, while underdiagnosis can result in patients not being treated on time. To deal with these problems, we construct a partially observable Markov decision process (POMDP) model of chronic diseases to study optimal diagnostic policies, which takes into account individual characteristics of patients. The objective of our model is to maximize a patient’s total expected quality-adjusted life years (QALYs). We also derive some structural properties, including the existence of the diagnostic threshold and the optimal diagnosis age for chronic diseases. The resulting optimization is applied to the management of coronary heart disease (CHD). Based on clinical data, we validate our model, demonstrate how the quantitative tool can provide actionable insights for physicians and decision makers in health-related fields, and compare optimal policies with actual clinical decisions. The results indicate that the diagnostic threshold first decreases and then increases as the patient’s age increases, which contradicts the intuitive non-decreasing thresholds. Moreover, diagnostic thresholds were higher for women than for men, especially at younger ages.

show abstract

“…The widely accepted core values of primary care, that it should provide easily accessible, continuous, comprehensive, and coordinated care 11,12 , are associated with improved population health 11,13 . This particularly applies to health care systems in which GPs act as gate keepers to secondary care, such as the Netherlands 14 .…”

Section: Introductionmentioning

confidence: 99%

Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care

Homburg

Brandenbarg²,

Hartman³

et al. 2022

BJGP Open

View full text Add to dashboard Cite

BackgroundChanges in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positive and negative.AimTo assess the experiences of patients of primary care during the COVID-19 pandemic.Design & settingA qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands.MethodA qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach.ResultsWe interviewed 28 patients (13 men and 15 women, age range 27–91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, or seeing unfamiliar doctors due to care being segregated.ConclusionsDespite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics but also when implementing permanent changes to care provision in primary care.

show abstract

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

Cited by 13 publications

References 53 publications

Spillover Effects of COVID-19 on Essential Chronic Care and Ways to Foster Health System Resilience to Support Vulnerable Non-COVID Patients: A Multistakeholder Study

Spillover Effects of COVID-19 on Essential Chronic Care and Ways to Foster Health System Resilience to Support Vulnerable Non-COVID Patients: A Multistakeholder Study

Diagnostic Policies Optimization for Chronic Diseases Based on POMDP Model

Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care

Contact Info

Product

Resources

About