Assessment Of Chronic Illness Care Research Articles

Effectiveness of a community care management program for multimorbid elderly patients with heart failure in the Veneto Region.

The rapidly growing population of elderly subjects with multimorbidity is at risk of receiving fragmented and uncoordinated care, and have frequent hospitalizations and emergency room (ER) visits. The study aims to describe the impact of a care management program (CMP) developed in the Veneto region (Northeastern Italy) for patients affected by chronic heart failure (CHF) and multimorbidity. The CMP was provided to 330 patients > 65years suffering from CHF and multimorbidity. They were compared to a propensity score matched reference group who received usual care. The intervention was provided by care manager nurses and General Practitioners working in the community. The quality of care from the patients' perspective was assessed by means of the Patient Assessment of Chronic Illness Care (PACIC). The effectiveness of the CMP has been evaluated comparing time changes in hospital admissions in the medical area and ER visits between the intervention and the reference group. The median PACIC overall score was 4 out of 5. The intervention group showed a reduction over time by 39% in hospitalization rates and by 33% in ER visits. The recourse to hospital care and ER did not change in the reference group. The current results indicate that a CMP can reduce Emergency Room visits and hospital admissions for elderly patients with CHF and multimorbidity. The CMP by emphasizing prevention, self-management, continuity and coordination of care, is beneficial among older community-dwelling multimorbid persons as compared to usual care.

Revisão da utilização do patient assessment of chronic ilness care

Brazil and the world have been facing an epidemic of chronic non communicable diseases (CDNT) and the current model of health care, traditionally based on responses to acute conditions, has not been able to meet demand. For this reason it was proposed to apply the Chronic Care Model (CCM) which presents new strategies for attention to chronic conditions. To achieve this, it is necessary that its implementation be monitored. Some instruments have been developed to facilitate the implementation and monitoring of CCM, including the Patient Assessment of Chronic Illness Care (PACIC), which has been empirically tested and supported by evidence from several studies. This study seeks to recognize how PACIC has been used in the evaluation of care in chronic diseases. For that, a review was made in the databases Scielo, BVS and Pubmed, from which 85 articles were analyzed. It was found that the PACIC could be better utilized by the researchers for several reasons.

A Transgenerational Study on The Beliefs About Medicines - Is Maternal Influence Stable Over Time?

Completion rates for medication therapy management (MTM) services have been lower than desired and the Centers for Medicare and Medicaid Services has added MTM comprehensive medication review (CMR) completion rates as a Part D plan star measure. Over half of plans utilize community pharmacists via contracts with MTM vendors.The primary objective of this survey study was to identify factors associated with the CMR completion rates of community pharmacies contracted with a national MTM vendor.Representatives from 27,560 pharmacy locations contracted with a national MTM vendor were surveyed. The dependent variable of interest was the pharmacies' CMR completion rate. Independent variables included the pharmacy's progressiveness stratum and number of CMRs assigned by the MTM vendor during the time period, as well as self-reported data to characterize MTM facilitators, barriers, delivery strategies, staffing, selected items from a modified Assessment of Chronic Illness Care, and pharmacist/pharmacy demographics. Univariate negative binomial models were fit for each independent variable, and variables significant at p < 0.05 were entered into a multivariable model.Representatives from 3836 (13.9%) pharmacy locations responded; of these, 90.9% (n = 3486) responses were useable. The median CMR completion rate was 0.42. Variables remaining significant at p < 0.05 in the multivariable model included: progressiveness strata; pharmacy type; scores on the facilitators scale; responses to two potential barriers items; scores on the patient/caregiver delivery strategies sub-scale; providing MTM at multiple locations; reporting that the MTM vendor sending the survey link is the primary MTM vendor for which the respondent provides MTM; and the number of hours per week that the pharmacy is open.Factors at the respondent (e.g., responses to facilitators scale) and pharmacy (e.g., pharmacy type) levels were associated with CMR completion rates. These findings could be used by MTM stakeholders to improve CMR completion rates.

Risk strata and quality of care for the elderly in Primary Health Care.

Objectiveto identify patterns of associations between the degree of compliance to laboratory test requests by risk strata and the parameters of quality of care outcomes in primary health care (PHC).Methoda cross-sectional study involving 108 elderly patients with hypertension and/or diabetes treated in PHC. A semi-structured questionnaire and electronic medical record data were used. To evaluate the quality of care, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used. Descriptive analysis, multiple correspondence analysis and k-means grouping were performed.Resultsit was observed low compliance of the care practice, standing out as the worst parameter the evaluation of the diabetic foot (2.2%). Three clusters were identified, with cluster 1 having the highest number of individuals (37.0%), with better indicators of quality of care, evidenced by above 50% of compliance with laboratory tests (75.0%), high PACIC score (47.2%), control of blood pressure (70.0%) and metabolic levels (95.0%), and satisfaction with health (92.5%) and health access (90.0%). In contrast, cluster 3 (29.6%) was made up of individuals with worse outcomes of care.Conclusionlow compliance of care practice and asymmetries among health actions and users’ needs were observed, indicating failures in the care process in PHC.

Quality of perinatal depression care in primary care setting in Nigeria

BackgroundEven though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries. This study assessed the existing organization of service for maternal mental health, the actual care delivered for perinatal depression, as well as the quality of the care received by affected women presenting to primary care clinics in Ibadan, Nigeria.MethodsThe Assessment of Chronic Illness Care (ACIC) tool was administered to the staff in 23 primary maternal care clinics and key informant interviews were conducted with 20 facility managers to explore organizational and administrative features relevant to the delivery of maternal mental health care in the facilities. Detection rate of perinatal depression by maternal care providers was assessed by determining the proportion of depressed antenatal women identified by the providers. The women were then followed up from the antenatal period up until 6 months after childbirth to track their experience with care received.ResultsAll the facilities had ACIC domain scores indicating poor capacity to offer quality chronic care. Emerging themes from the interviews included severe manpower shortage and absence of administrative and clinical support for manpower training and care provision. Only 31 of the 218 depressed women had been identified by the maternal care providers as having a psychological problem throughout the follow-up period. In spite of the objective evidence of inadequate care, most of the perinatal women rated the service provided in the facilities as being of good quality (96%) and reported being satisfied with the care received (98%).ConclusionThere are major inadequacies in the organisational and administrative profile of these primary maternal care facilities that militate against the provision of quality chronic care. These inadequacies translate to a large treatment gap for women with perinatal depression. Lack of awareness by service users of what constitutes good quality care, indicative of low service expectation, may hamper user-driven demand for quality improvement.

Impact of a Boot Camp Translation Intervention on Self-Management Support in Primary Care: A Report From the INSTTEPP Trial and Meta-LARC Consortium.

Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks' Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools. INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager from each of 4 practices) and subsequent implementation. Outcome measures for patients were the Patient Activation Measure (PAM), self-rated health, and Patient Assessment of Chronic Illness Care (PACIC) process-of-care items at baseline, 1 and 2 months. Clinician Support for Patient Activation Measure (CS-PAM) and theory of planned behavior outcomes were assessed at 5 points over 10 months for clinicians and staff. A total of 297 patients and 89 practice staff and clinicians completed surveys during the study. Over successive 2-month sampling periods, intervention patients experienced greater improvement in PACIC process of care and self-rated health compared to control patients (P<0.0001 and P=0.0273, respectively). PAM (P=0.3515), CS-PAM (P=0.7464), and theory of planned behavior outcomes (P>0.10 for all) were not significantly different. Significant effects on process of care and self-rated health are evidence that the boot camp translation intervention impacted SMS. A larger trial with a typical 6-month boot camp intervention may show significant effects on other outcomes.

Integrated Care for High-need High-cost Patients: The Comprehensive Care for Multimorbid Adults Program (CC-MAP)

Introduction : Multimorbidity, the co-occurrence of chronic conditions, is common and associated with substantial burden to patients and healthcare systems. Yet, evidence on the effectiveness of multimorbid primary care programs is limited. We aimed to describe the Comprehensive Care for Multimorbid Adults Program (CC-MAP) and report 12-month hospitalization, quality of life and quality of care outcomes. Methods : A cluster-controlled design of primary care clinics in Clalit Health Services, Israel's largest non-for-profit insurer and provider of services. A total of 1200 (600 in each arm) high-risk multimorbid patients were recruited for a study of primary care clinics participating in the intervention and in comparable, usual care, controls. Clinics with a high proportion of patients with high morbidity burden, measured by the Johns Hopkins Adjusted Clinical Groups (JH-ACG)® weighted score, where chosen for the intervention and similar clinics were chosen as controls . In each of the intervention clinics, a nurse collaborated with 3-4 primary care physicians (PCP) to care for the 100 highest-risk multimorbid patients. Nurses performed comprehensive assessment; designed an all-inclusive care plan; developed a patient tailored action-plan, provide integration of all services and care transitions, and provided self-management support, and care integration. The PCP collaborated with the CC-MAP nurse, mainly in regards to receiving information from the comprehensive assessment she performed and in the joint creation of the care plan and its follow-up. Unplanned hospitalizations, self-reported physical component score (PCS) and mental component score (MCS) of the SF-12v2, and quality of care (using the Patient Assessment of Chronic Illness Care, [PACIC]), were assessed 12 months after recruitment. Results : Patients in the control group were not significantly different from patients in the intervention in regards to clinical characteristics and prior hospitalizations. PCS and PACIC scores were significantly higher in the intervention versus controls (p Discussions : The CC-MAP provides an effective comprehensive approach to reduce unwarranted healthcare utilization and maintain physical status of multimorbid patients. Conclusions : The CC-MAP provides an effective approach to patient selection and care provision for multimorbid patients, resulting in improved care, physical quality of life and reduced unplanned admissions. The program was recently expanded and currently includes 12 clinics in 3 districts. Lessons Learned : This study demonstrates the key features of successful multimorbidity primary care management programs and principles of equitable high-risk multimorbid case selection. The mental health components of the intervention should be strengthened. Limitations : The health care setting in which the study was performed (a large, integrated type of health care delivery system) may not resemble other health care systems. Nonetheless, similar principles of comprehensive multimorbid care management may be generalized. Suggestions for future research : Future research should examine long-term patients’ outcomes, as well as the involvement of patient’s caregivers’ in this process.

Randomized Controlled Trial of Health Coaching for Vulnerable Patients with Chronic Obstructive Pulmonary Disease.

Socioeconomically disadvantaged patients with chronic obstructive pulmonary disease (COPD) often face barriers to evidence-based care that are difficult to address in public care settings with limited resources. To determine the benefit of health coaching for patients with moderate to severe COPD relative to usual care. We conducted a randomized controlled trial of 9 months of health coaching versus usual care for English- or Spanish-speaking patients at least 40 years of age with moderate to severe COPD. Primary outcomes were COPD-related quality of life and the dyspnea subscale of the Chronic Respiratory Disease Questionnaire. Secondary outcomes were self-efficacy for managing COPD, exercise capacity (6-min walk test), and number of COPD exacerbations. Additional outcomes were COPD symptoms, lung function (forced expiratory volume in 1 s percent predicted), smoking status, bed days owing to COPD, quality of care (Patient Assessment of Chronic Illness Care), COPD knowledge, and symptoms of depression (Patient Health Questionnaire). Outpatient visits, emergency department visits, and hospitalizations were assessed by review of medical records. Generalized linear modeling was used to adjust for baseline values and account for clustering by clinic. Of 192 patients enrolled, 158 (82%) completed 9 months of follow-up. There were no significant differences between study arms for the primary or secondary outcomes. At 9 months, patients in the coached group reported better quality of care (mean Patient Assessment of Chronic Illness Care score, 3.30 vs. 3.18; adjusted P = 0.02) and were less likely to report symptoms of moderate to severe depression (Patient Health Questionnaire score, ≥15) than those in the usual care arm (6% vs. 20%; adjusted P = 0.01). During the study, patients in the coaching arm had 48% fewer hospitalizations related to COPD (0.27/patient/yr vs. 0.52/patient/yr), but this difference was not significant in the adjusted analysis. These results help inform expectations regarding the limitations and benefits of health coaching for patients with COPD. They may be useful to health policy experts in assessing the potential value of reimbursement and incentives for health coaching-type activities for patients with chronic disease. Clinical trial registered with www.clinicaltrials.gov (NCT02234284).

Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.

Primary care teams face daily time pressures both during patient encounters and outside of appointments. We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure. Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients. Patients (n=1291 respondents, 73.5% response rate) with diabetes and/or coronary artery disease established with practice teams (n=353 respondents, 84% response rate) at 16 primary care sites, randomly selected from 2 Accountable Care Organizations. We measured team member perceptions of 2 potentially distinct time pressure constructs: (1) encounter-level, from 7 questions about likelihood that time pressure results in missing patient management opportunities; and (2) practice-level, using practice atmosphere rating from calm to chaotic. The Patient Assessment of Chronic Illness Care (PACIC-11) instrument measured patient-reported experience. Multivariate logistic regression models examined organizational predictors of each time pressure type, and hierarchical models examined time pressure predictors of patient-reported experiences. Encounter-level and practice-level time pressure measures were not correlated, nor predicted by the same organizational variables, supporting the hypothesis of two distinct time pressure constructs. More encounter-level time pressure was most strongly associated with less health information technology capability (odds ratio, 0.33; P<0.01). Greater practice-level time pressure (chaos) was associated with lower PACIC-11 scores (odds ratio, 0.74; P<0.01). Different organizational factors are associated with each forms of time pressure. Potential consequences for patients are missed opportunities in patient care and inadequate chronic care support.

Variation in Medication Therapy Management Delivery: Implications for Health Care Policy.

Medication therapy management (MTM) program evaluations have revealed mixed outcomes, with some studies finding favorable outcomes and others finding no differences between patients who received MTM versus those who did not. One possible reason for outcomes variability is differences in delivery of MTM programs. The Chronic Care Model (CCM) provides a framework for how health care organizations can improve care for the chronically ill through 6 elements: organization of health care, delivery system design, clinical information systems, decision support, self-management, and linkages to community resources. To apply the CCM to understand variation in MTM delivery and formulate policy recommendations. This study used a mixed-methods descriptive analysis of MTM delivery. Investigators conducted visits to a purposeful sample of MTM practices to observe MTM and interview participants. The pharmacists and staff of these practices completed a modified Assessment of Chronic Illness Care (ACIC). Pairs of investigators analyzed interview transcripts to identify themes. Demographics and ACIC scores were summarized using descriptive statistics. After analysis, investigators discussed overarching themes and policy implications organized by CCM elements. Seven practices participated, and 87 participants were interviewed. Based on ACIC scores, MTM patient volume, and payer mix, practices were categorized as Early Maturity Level or Later Maturity Level. From the model, organization of health care themes included whether MTM was the practice's core competence, belief/confidence in the MTM process, lack of formal rewards, and the influence of organizational goals and external environment. Delivery system design themes pertained to the extent that MTM processes were formalized. Clinical information systems themes were the extent to which systems were influenced by payers, efficiency strategies, and the accuracy and availability of information. In considering clinical decision support themes, alert design limitations and variation in user approaches to alerts based on experience were noted. We observed strong support for patient self-management; when present, barriers were attributed to the patient, MTM provider, or payer. Referral to community resources was minimal. Numerous policy implications were identified. Our research identified numerous ways by which MTM delivery varies, particularly by MTM practice maturity level. These findings provide evidence for several policy changes that could be considered to optimize MTM delivery, encourage alignment with the CCM, and promote practice maturation. This research and a portion of Snyder's salary were supported by grant number K08HS022119 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Snyder reports consulting fees from Westat for an evaluation of the CMS Enhanced MTM program. The other authors have nothing to disclose. Portions of this research have been presented as abstracts at the following conferences: (a) 2017 Academy Health Annual Research Meeting; June 25-27, 2017; New Orleans, LA; (b) 2015 American Society of Health-System Pharmacists Clinical Midyear Meeting; December 4-8, 2015; New Orleans, LA; and

Patient activation for self-management is associated with health status in patients with atrial fibrillation.

BackgroundHigher levels of patient activation for self-managing health are associated with positive clinical and health care utilization outcomes. Identifying a patient’s activation level can guide clinicians to tailor interventions to improve their health. Effective self-management of atrial fibrillation (AF) requires patient activation to participate in treatment decisions, prevent complications, and manage risk factors. Yet, little is known about activation in patients with AF. The purpose of this descriptive study was to identify patient activation levels and factors associated with activation in patients with AF.MethodsPatients (N=123), 66% male, with a mean (SD) age of 59.9 (11.3) years seeking treatment for AF at an arrhythmia clinic completed the Patient Activation Measure (PAM), Atrial Fibrillation Severity Scale, Knowledge about Atrial Fibrillation test, Hospital Anxiety Depression Scale, Godin Leisure-Time Exercise Questionnaire, and Patient Assessment of Chronic Illness Care. Sociodemographic and clinical data were obtained from medical records. PAM scores were categorized into Levels 1–4. Associations among patient-reported outcomes, sociodemographic, and clinical variables were analyzed using Fisher’s exact tests and Kruskal–Wallis procedures.ResultsThe PAM scores of nearly half (45.5%) of the patients were at Level 3, while the scores of 38% were at Level 4. Male sex (P=0.02), higher education (P=0.004), being employed (P=0.005), lower body mass index (P=0.03), tobacco abstinence (P=0.02), less AF symptom burden (P=0.006), less depression (P≤0.0001) and anxiety (P=0.006), greater knowledge of AF (P=0.01), and higher levels of physical activity (P=0.02) were associated with higher activation levels.ConclusionHigher levels of patient activation in those with AF were associated with a more positive health status and educational attainment. Additional research to describe activation in patients with AF is warranted to identify patients at risk for low activation and to tailor interventions to activation level.

Assessment of hypertension chronic care model: Pacic application in Bosnia and Herzegovina.

The objectives of this study were to evaluate patients’ attitudes towards hypertension treatment according to the chronic care model and to assess the implementation of hypertension clinical guidelines in family medicine. The cross-sectional study was carried out in two randomly selected primary health care centers (Bijeljina and Prijedor), respectively in Bosnia and Herzegovina, covering the period between March and April 2016. This study sample consists of 791 respondents with hypertension purposing to measure specific actions and quality of care for hypertensive patients. The Patient Assessment of Chronic Illness Care (PACIC) was used. Treatment for the indicators of hypertension was assessed by analyzing patients' medical charts according to the recommendations of clinical guidelines. More than half of the evaluated indicators of treatment for hypertension were documented in medical charts of 84.07% patients. The average overall PACIC score was 4.18 (SD 0.59), being an average of the separate scores of 4.19 (SD 0.57) in men and 4.17 (SD 0.60) in women. Subscale means of PACIC were as follows: patient activation 4.33, delivery system design 4.36; goal setting 4.03; problem solving 4.51; follow-up and co-ordination 3.67. No statistically significant correlations in the overall score and subscale scores were found by demographic characteristics. Non-smokers had a significantly higher overall score compared to smokers (p = 0.001). As implementation of the guidelines became stronger, the reported PACIC scores rose. Continuing the education of patients in order to achieve better health care outcomes is imperative.

Translation and validation of the PACIC+ questionnaire: the Thai version

BackgroundThe number of patients with chronic illness is increasing worldwide. These patients usually receive care from a primary care facility. The Patient Assessment of Chronic Illness Care (PACIC) is a tool that is increasingly used in several countries to measure how the patients perceive the care they receive. The goal of this validation study is to provide and validate an extended version of the tool, the PACIC+ questionnaire, in Thailand.MethodsIn this observational validation study, patients with type 2 diabetes from the outpatient clinic at a university hospital in Thailand completed the PACIC+ at the clinic. For follow-up, they received the questionnaire per mail after four weeks. The Thai PACIC+ comprises 26 items, which map onto 5 subscales and a summary score related to the Chronic Care Model (CCM) and 5 subscales and a summary score related to the 5A model, a counseling model for behavioral changes. Data-analysis focused on the use of most extreme answering categories (> 15%), internal consistency (Cronbach’s alpha), and test-retest reliability. An exploratory factor analysis (EFA) was performed for the CCM and the 5A model separately to examine the factor structure.ResultsA total of 151 patients participated. The average age of the sample was 63 ± 9 years (range 29–86 years). Fifty-three percent of the respondents were female. In the Delivery System subscale, 20% of patients reported the highest possible value; in all other subscales, relative frequencies of the most extreme categories did not exceed 15%. Cronbach’s alpha per subscale varied from 0.58 to 0.81, while that of the summary scores were 0.89 and 0.91. The mean difference from the test-retest varied from − 0.06 to 0.17 across subscales. The Kaiser-Meyer-Olkin criterion for sampling adequacy (KMO) was good for both models as well as the Bartlett’s test for sphericity p. While the factor loadings in rotated factor solution showed good concordance with the CCM, concordance was not as good for the 5A model, especially for the subscales “Assess” and “Advice”.ConclusionA validated Thai version of the PACIC+ is now available to measure how the patients perceive the care they receive.

Evaluating T1DM Patient Experience Using the Patient Assessment of Chronic Illness Care Survey

Aligning diabetes care with components of the Chronic Care Model (CCM) facilitates productive interactions between a proactive care team and an informed, activated patient, allows the care plan to be individualized, and can improve care and outcomes. The Patient Assessment of Chronic Illness Care (PACIC) survey assesses patient experience with CCM-based healthcare delivery components. In the Division of Diabetes and Endocrinology at Scripps Health, a large integrated health system in San Diego, CA, patients with T1DM have access to an interdisciplinary team of clinicians who provide care, education, and ongoing support. Guided by the CCM, an interactive care delivery system involving the endocrinologist, PCP, diabetes educator, RD, behavioral specialist and the patient was implemented to facilitate proactive and productive care but some interactions remained isolated. Between June and August 2017, the PACIC survey was administered by research assistants to N=47 adults with T1DM who have received care in the Division for at least 6 months. Overall, patients reported high satisfaction with care (M=4.77 out of 5; SD=0.56). Results also indicated high ratings for specific CCM elements, including Patient Activation, Delivery System Design/Decision Support, and Self-Management Support (M=4.29-4.55). Lower ratings were observed for Follow-Up/Coordination (M=3.81; SD=1.01), suggesting a need for enhanced post-visit contact with patients, referrals to community programs, dietitians, and counselors, and discussion of specialist appointments. In line with the Institute for Healthcare Improvement’s Triple Aim focused on improving the health of populations through optimization of health system performance, an RN with specialized experience in T1DM was added to the team as the Diabetes Care Manager to assist with follow-up and care coordination. The PACIC will be re-administered after 6 months to determine the impact on patient perceptions of follow-up/coordination between visits. Disclosure R. Morrisey: None. E. Kaczmar: None. A. Tsimikas: None. F.M. Arnold: None. T. Clark: None. J. McCallum: None. A.L. Fortmann: None.

Effects of a Primary Care–Based Chronic Care Model on Diabetes Self-Management, Diabetes Distress, and Health Care Experience

By 2034, the number of U.S. individuals with diabetes is predicted to increase from 23.7 to 44.1 million, and annual diabetes-related spending is expected to grow from $113 to $336 billion. Current healthcare systems are often not equipped to support the growing diabetes population, and many individuals are not achieving clinical targets necessary for preventing diabetes complications and for improving long-term survival. To address this need, an innovative, Chronic Care Model (CCM)-based care management program was developed that used clinical risk stratification, standardized decision support tools, RN + health coach + PCP team-based care, and a depression care manager. N=236 T1D and T2D (96%) patients (M age = 61.9 ± 11.4 years; 51% male) were enrolled at a San Diego clinic that includes diverse payors and an integrated PCP group. This care management program was previously shown to achieve significant improvements in cardiometabolic outcomes (HbA1c, LDL-c) and health care costs relative to usual care at 1-year. The present analysis evaluated effects on diabetes self-management (Summary of Diabetes Self Care Activities) and distress (Diabetes Distress Scale), and patients’ experience with CCM-based healthcare delivery components (Patient Assessment of Chronic Illness Care). Statistically significant improvements were observed in healthful eating (5 vs. 4 days/week), exercise (5 vs. 3), blood glucose monitoring (5 vs. 4), foot-checking (5 vs. 3), and diabetes distress (14% vs. 24% with moderate distress) over 12 months (ps &amp;lt; .05). Patients’ perceptions of follow-up/care coordination, support for patient activation and self-management, and delivery design also improved over this period (ps &amp;lt; .05). Taken together, this population-based care management program represents an approach that can improve clinical, behavioral, psychosocial and cost outcomes, and health care delivery experience for people with diabetes in the primary care environment. Disclosure A.L. Fortmann: None. J.L. Preciado: None. C. Walker: None. R. Morrisey: None. K. Barger: None. D. Mills: None. M. Robacker: None. A. Philis-Tsimikas: Research Support; Self; Dexcom, Inc.. Advisory Panel; Self; Dexcom, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; Novo Nordisk A/S, Sanofi, Mylan. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc.. Stock/Shareholder; Spouse/Partner; Esperion Therapeutics, Ionis Pharmaceuticals, Inc.. Advisory Panel; Self; AstraZeneca.

Patients\u2019 assessment of chronic illness care: a validation study among patients with type 2 diabetes in Finland

BackgroundTo meet the challenges of the rising prevalence of chronic diseases, such as type 2 diabetes, new approaches to healthcare delivery have been initiated; among these the influential Chronic Care Model (CCM). Valid instruments are needed to evaluate the public health impact of these frameworks in different countries. The Patient Assessment of Chronic Illness Care (PACIC) is a 20-item quality of care measure that, from the perspective of the patient, measures the extent to which care is congruent with the CCM. The aim of this study was to evaluate the psychometric properties of the Finnish translation of the PACIC questionnaire, in terms of validity and reliability, in a large register-based sample of patients with type 2 diabetes.MethodThe PACIC items were translated into Finnish in a standardized forward-backward procedure, followed by a cross-sectional survey among patients with type 2 diabetes (response rate 56%; n = 2866). We assessed the Finnish version of the PACIC scale for the following psychometric properties: content validity, internal consistency reliability, convergent and construct validity. We also present descriptive data on total scale as well as predetermined subscale levels.ResultsThe item-response on the PACIC scale was high with only small numbers of missing data (0.5–1.1%). Ceiling effects were low (0.3–5.3%) whereas floor effects were over 20% for two of the predetermined subscales (problem solving and follow-up/coordination). The total PACIC scale showed a reasonable distribution and excellent internal consistency (alpha 0.94) while the internal consistency of the subscales were at least acceptable (0.74–0.86). The principal component analysis identified a two- or three-factor solution instead of the proposed five-dimensional. In other respects, the PACIC scale showed the hypothesized relationships with quality of care and outcome measures, thus demonstrating convergent and construct validity.ConclusionA Finnish version of the PACIC scale is now validated in the primary care setting among patients with type 2 diabetes. The findings suggest comparable psychometric properties of the Finnish scale as of the original English instrument and earlier translations, and reasonable levels of validity and reliability.

A pilot study assessing patient-centred care in patients with chronic health conditions attending chiropractic practice

ObjectivesThe primary aim of this pilot study was to determine the feasibility of conducting a mixed- methods study assessing the extent patients with chronic health conditions perceive chiropractic care to be patient-centred. DesignA sequential mixed methods feasibility study with a quantitative priority. SettingTwo private chiropractic clinics in Calgary, Alberta, Canada. Main outcome measuresFeasibility outcomes included pilot study participation, consent and completion rates. Demographic and health information and a modified version of the Patient Assessment of Chronic Illness Care (PACIC). ResultsOver three weeks, 90 participants were recruited, 86 enrolled, and 78 provided complete data, with only one who commented on the clarity of paperwork. Included participants were on average 47.1 years of age and 60.3% were female. They had an average of 1.8 chronic conditions with 60% having chronic spinal pain. They reported seeing an average of 2.9 other health professionals for their chronic health condition and averaged 12.9 chiropractic visits in the past year. The average overall modified PACIC score was 3.29 on a 5-point scale. Higher scores were seen on the ‘patient activation’, ‘delivery system design/decision support’, and ‘problem solving/contextual’ subscales, with lower scores seen on the ‘goal-setting/tailoring’ and ‘follow-up/coordination’ subscales. Interview data generally supported those findings. ConclusionsThe pilot study results support the feasibility of the methods for a subsequent large-scale study. These preliminary results suggest that the degree of patient-centredness compares favourably to similar studies in primary medical care.

The use of the Patient Assessment of Chronic Illness Care (PACIC) instrument in diabetes care: a systematic review and meta-analysis.

The Patient Assessment of Chronic Illness Care (PACIC) was created to assess whether provided care is congruent with the Chronic Care Model, according to patients. We aimed to identify all studies using the PACIC in diabetic patients to explore (i) how overall PACIC scores varied across studies and (ii) whether scores varied according to healthcare delivery, patient and instrument characteristics. MEDLINE, Embase, PsycINFO, CINAHL and PubMed Central (PMC), from 2005 to 2016. Studies of any design using the PACIC in diabetic patients. We extracted data on healthcare delivery, patient, and instrument characteristics, and overall PACIC score and standard deviation. We performed random-effects meta-analyses and meta-regressions. We identified 34 studies including 25 942 patients from 13 countries, mostly in North America and Europe, using different versions of the PACIC in 11 languages. The overall PACIC score fluctuated between 1.7 and 4.2, with a pooled score of 3.0 (95% confidence interval 2.8-3.2, 95% predictive interval 1.9-4.2), with very high heterogeneity (I2 = 99%). The PACIC variance was not explained by healthcare delivery or patient characteristics, but by the number of points on the response scale (5 vs. 11) and the continent (Asia vs. others). The PACIC is a widely used instrument, but the direct comparison of PACIC scores between studies should be performed with caution as studies may employ different versions and the influence of cultural norms and language on the PACIC score remains unknown.

Validation of the Patient Assessment of Chronic Illness Care (PACIC) Instrument in the Republic of Srpska, Bosnia and Herzegovina

Rationale, aims and objectives: To translate, culturally adapt and preliminary validate the original English version of the PACIC questionnaire into the Serbian language, in the Republic of Srpska, Bosnia and Herzegovina and to assess the relationship between PACIC scores and clinical guidelines implementation in family medicine.Methods: A cross-sectional study was implemented in 2 primary healthcare centers. The translated PACIC questionnaire was administered to 206 consecutive patients with hypertension, diabetes mellitus and/or chronic obstructive pulmonary disease. The validity and reliability of the Serbian version of PACIC has been tested with face validity, construct validity and internal consistency. The PACIC score and its 5 subscales were tested using Kruskal-Wallis or Mann-Whitney test. The relationship of the PACIC score and guidelines implementation was analyzed by multiple linear regression.Results: The overall PACIC score indicates an implementation of the Chronic Care Model (CCM) occurred “most of the time”. Of the 5 subscales, average scores were highest on “Delivery system/decision support”. CCM in “Follow up/Coordination” occurred sometimes. Cronbach’s alpha coefficient showed a high internal consistency level for the PACIC questionnaire. Kaiser-Meyer-Olkin Measure of Sampling Adequacy is 0.917 and Bartlett’s test of sphericity is significant (p≤0.001). Four factors were identified explaining 69% of total variance.Conclusions: There was a significant relationship between the PACIC score and the implementation of the chronic disease clinical guidelines. The PACIC questionnaire is advanced as a reliable and internally consistent instrument of use in increasing the person-centeredness of care of chronic illness.

How Views of the Organization of Primary Care Among Patients with Hypertension Vary by Race or Ethnicity.

We assessed potential racial or ethnic differences in the degree to which veterans with pharmaceutically treated hypertension report experiences with their primary care system that are consistent with optimal chronic illness care as suggested by Wagner's Chronic Care Model (CCM). A cross-sectional analysis of the results of the Patient Assessment of Chronic Illness Care (PACIC), which measured components of the care system suggested by the CCM and was completed at baseline by participants in a hypertension disease management clinical trial. Participants had a recent history of uncontrolled systolic blood pressure. Among 377 patients, non-Hispanic African American veterans had almost twice the odds of indicating that their primary care experience is consistent with CCM features when compared with non-Hispanic White patients (odds ratio (OR) = 1.86; 95% confidence interval (CI) = 1.16-2.98). Similar statistically significant associations were observed for follow-up care (OR = 2.59; 95% CI = 1.49-4.50), patient activation (OR = 1.80; 95% CI = 1.13-2.87), goal setting (OR = 1.65; 95% CI = 1.03-2.64), and help with problem solving (OR = 1.62; 95% CI = 1.00-2.60). Non-Hispanic African Americans with pharmaceutically treated hypertension report that the primary care system more closely approximates the Wagner CCM than non-Hispanic White patients.