Abstract
BackgroundTo 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.MethodsWe 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.ResultsCompared 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.ConclusionsThe 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.
Highlights
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)
Low- and middle-income countries (LMICs) do face a disproportionately heavy burden of chronic noncommunicable diseases (NCD), and have difficulties in scaling-up service delivery models such as the Chronic Care Model (CCM), a well-structured approach to caring for patients with chronic diseases, which has proven effective in high-income countries [1, 2]
Empirical data on the application of CCM or other strategies to address healthcare needs of patients with NCD in primary care settings of LMICs has primarily been confined to pilot scale or individual studies [3, 4]
Summary
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). Low- and middle-income countries (LMICs) do face a disproportionately heavy burden of chronic noncommunicable diseases (NCD), and have difficulties in scaling-up service delivery models such as the Chronic Care Model (CCM), a well-structured approach to caring for patients with chronic diseases, which has proven effective in high-income countries [1, 2]. CCM is a well-accepted approach to improve the quality of care of chronic diseases. It comprises six domains: community, health system, self-management support, delivery system design, decision support and clinical information system [5]. LMIC health systems require human and institutional capacity strengthening to improve the effectiveness, quality, distribution, and continuity of care through smart designs and use of technology [6, 7]. In low- and middle-income country settings, adapting disease guidelines requires non-physician clinicians to deliver care and to ensure effective implementation of standardised protocols for diagnosis, treatment, and monitoring [7, 8]
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