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.
Highlights
The increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations
The question asked by this review was: What attitudes, beliefs, expectations, understandings, perceptions, experiences, resources and knowledge according to healthcare providers and patients support or inhibit the implementation of chronic care model (CCM) within a primary healthcare setting?
Inclusion criteria Population and context This review considered studies that focused on patients with one or more of the more prevlant major chronic diseases as defined by the World Health Organisation cardiovascular disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus and depression [18, 19] - receiving care in primary healthcare settings, as well as all primary healthcare providers such as doctors, nurses and administrators
Summary
Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM). The increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations [1, 2]. Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM) which was first developed by MacColl Institute for Healthcare Innovation at Group Health Cooperative in the early 1990s [3,4,5]. The. The implementation of complex interventions such as CCMs requires careful consideration and planning. Primary healthcare services need to consider the range of interacting factors
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