Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy

Milena Vainieri,Anna Maria Murante,Mauro Maccari,Sara Barsanti,Cecilia Quercioli

doi:10.1186/s12913-018-3431-0

Milena Vainieri, Anna Maria Murante + Show 3 more

Open Access

https://doi.org/10.1186/s12913-018-3431-0

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Abstract

BackgroundMore and more countries have been implementing chronic care programs, such as the Chronic Care Model (CCM) to manage non-acute conditions of diseases in a more effective and less expensive way. Often, these programs aim to provide care for single conditions instead of the sum of diseases. This paper analyzes the satisfaction and better management of single and multiple chronic patients with the core elements of chronic care programs in Siena, Italy. In addition, the paper also considers whether the CCM introduced in Siena has any influence on satisfaction and better self-management.MethodsSurvey data from patients with single chronic (N = 500) and multiple chronic diseases (N = 454), assisted by the Local Health Authority in Siena (Tuscany, Italy), were considered for the analysis. Variables on education, monitoring system, proactivity, relational continuity, model of care (CCM versus no CCM) and patient demographics were used to detect which strategies are associated with a higher patient-reported ability to better self-manage the disease and overall patient satisfaction. Logistic and ordinary logistic models were executed on data related to patients with both single and multiple chronic diseases.ResultsThe results showed that monitoring was the sole strategy associated with overall satisfaction and better self-management for both single and multiple chronic patients. Relational continuity also showed a significant positive association with better self-management perception for both patient groups, but had a positive association with patient satisfaction only for single chronic patients. Enrolment in the CCM was not associated with both overall satisfaction and better management for the two patient groups.ConclusionsStrategies that are significantly associated with satisfaction and perception of better disease self-management were the same for both single and multiple chronic patients. The delivery of care based on the Siena CCM does not seem to make a difference in the perception of better self-management and overall satisfaction for all the patients. Other concurrent strategies implemented by the regional government in Tuscany on primary care monitoring and health promotion could partially explain why CCM does not have a significant influence.

Highlights

More and more countries have been implementing chronic care programs, such as the Chronic Care Model (CCM) to manage non-acute conditions of diseases in a more effective and less expensive way
Disease Management Program (DMP) are based on specific components, such as the integration of community resources, self-management support, delivery system redesign, decision support systems, clinical information systems, and organizational support
On the basis of this evidence, we argue that the improvements introduced in Tuscany by these integrated governance tools clouded out the benefits coming from CCM program encouraging all General Practitioners (GP) to follow the core chronic care strategies

Summary

Introduction

More and more countries have been implementing chronic care programs, such as the Chronic Care Model (CCM) to manage non-acute conditions of diseases in a more effective and less expensive way. DMPs are based on specific components, such as the integration of community resources, self-management support, delivery system redesign, decision support systems, clinical information systems, and organizational support. Among these components, self-management is considered an essential factor of chronic care treatment [1] because it significantly impacts on the quality of patients’ daily lives, on their physical and mental well-being [2], their active participation in self-monitoring and/or decision making processes [3], by improving patients’ knowledge and skills [4, 5]. The Chronic Care Model (CCM) and its adaptations are examples of proactive disease management approaches that aim to manage the non-acute/chronic conditions in a more effective and less expensive way [7, 8]

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