Implementing elements of a context-adapted chronic care model to improve first-line diabetes care: effects on assessment of chronic illness care and glycaemic control among people with diabetes enrolled to the First-Line Diabetes Care (FiLDCare) Project in the Northern Philippines.

Abstract

Aim The purpose of this study was to investigate the effects of implementing elements of a context-adapted chronic disease-care model (CACCM) in two local government primary healthcare units of a non-highly urbanized city and a rural municipality in the Philippines on Patients' Assessment of Chronic Illness Care (PACIC) and glycaemic control (HbA1c) of people with diabetes. Low-to-middle income countries like the Philippines are beset with rising prevalence of chronic conditions but their healthcare systems are still acute disease oriented. Attention towards improving care for chronic conditions particularly in primary healthcare is imperative and ways by which this can be done amidst resource constraints need to be explored. A chronic care model was adapted based on the context of the Philippines. Selected elements (community sensitization, decision support, minor re-organization of health services, health service delivery-system re-design, and self-management education and support) were implemented. PACIC and HbA1c were measured before and one year after the start of implementation. Findings The improvements in the PACIC (median, from 3.2 to 3.5) as well as in four of the five subsets of the PACIC were statistically significant (P-values: PACIC=0.009; 'patient activation'=0.026; 'goal setting'=0.017; 'problem solving'<0.001; 'follow-up'<0.001). The decrease in HbA1c (median, from 7.7% to 6.9%) and the level of diabetes control of the project participants (increase of optimally controlled diabetes from 37.2% to 50.6%) were likewise significant (P<0.000 and P=0.014). A significantly higher rating of the post-implementation PACIC subsets 'problem solving' (P=0.027) and 'follow-up' (P=0.025) was noted among those participants whose HbA1c improved. The quality of chronic care in general and primary diabetes care in particular may be improved, as measured through the PACIC and glycaemic control, in resource-constrained settings applying selected elements of a CACCM and without causing much strain on an already-burdened healthcare system.