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

Chuan De Foo,Geronimo Jimenez,Gerald Choon Huat Koh,John Pastor Ansah,Shilpa Surendran,David Bruce Matchar

doi:10.3390/ijerph18062926

Abstract

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

Highlights

As the world ages at a rapid pace, the number of patients with chronic conditions is set to increase in tandem
Our results showed that the primary care network (PCN) did fulfil most of the criteria set forth by Starfield’s
The various aspects of the “4Cs” and suggested enhancements will be elaborated in our discussion

Summary

Introduction

As the world ages at a rapid pace, the number of patients with chronic conditions is set to increase in tandem. The uptick in chronic disease load had led to an overwhelming burden on healthcare infrastructure and national health expenditures [2,3,4] This affliction is accrued from the systematic stress precipitated by higher bed occupancies, hospital readmission numbers and emergency medicine interventions [5,6,7]. This perpetuating strain has created the catalyst to provide chronic disease management services for stable patients at the community level in order to free up health care resources at the tertiary care interface [8].

Objectives

Methods

Discussion

Conclusion