Abstract
BackgroundPrimary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings.MethodsThe methods were based on our previous review published in 2006. We performed database searches for articles published from 2006 to 2014 and conducted a systematic review with narrative synthesis using the Cochrane Effective Practice and Organisation of Care taxonomy to classify interventions and outcomes. The interventions were mapped to Chronic Care Model elements. The pattern of outcomes related to interventions was summarized by frequency of statistically significant improvements in health care provision and patient outcomes.ResultsA total of 9589 journal articles were retrieved from database searches and snowballing. After screening and verification, 165 articles that detailed 157 studies were included. There were few studies with Health Care Organization (1.9% of studies) or Community Resources (0.6% of studies) as the primary intervention element. Self-Management Support interventions (45.8% of studies) most frequently resulted in improvements in patient–level outcomes. Delivery System Design interventions (22.6% of studies) showed benefits in both professional and patient-level outcomes for a narrow range of conditions. Decision Support interventions (21.3% of studies) had impact limited to professional-level outcomes, in particular use of medications. The small number of studies of Clinical Information System interventions (8.9%) showed benefits for both professional- and patient-level outcomes.ConclusionsThe published literature has expanded substantially since 2006. This review confirms that Self-Management Support is the most frequent Chronic Care Model intervention that is associated with statistically significant improvements, predominately for diabetes and hypertension.
Highlights
Primary and community care are key settings for the effective management of long term conditions
The majority of the studies were of Randomized controlled trial (RCT) design (92.9%), allocating the intervention at the patient-level (63.2%), and based in primary care (62.6%)
This review demonstrated benefits from implementation of interventions based on Chronic Care Model (CCM) elements in primary care
Summary
Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings. The Global Burden of Disease study 2013 reported a substantial (42.3%) increase in the years lived with disability (YLD) from 1990 to 2013 [2]. This was overwhelming due to non-communicable diseases, with no infectious diseases in the top 20 leading causes of YLDs globally in. Addressing chronic disease is a major challenge for healthcare systems around the world, which have largely developed to deal with acute episodic care, rather than to provide organized care for people with long-term conditions [5].
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