Chronic Disease Management in Primary Care: From Evidence to Policy

School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
The Medical journal of Australia (Impact Factor: 4.09). 05/2008; 188(8 Suppl):S53-6.
Source: PubMed


To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care.
We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were classified according to which elements were addressed: community resources, health care organisation, self-management support, delivery system design, decision support and/or clinical information systems. Our major findings were discussed with policymakers and key stakeholders in relation to current and emerging health policy in Australia.
The interventions most likely to be effective in the context of Australian primary care were engaging primary care in self-management support through education and training for general practitioners and practice nurses, and including self-management support in care plans linked to multidisciplinary team support. The current Practice Incentives Payment and Service Incentives Payment programs could be improved and simplified to encourage guideline-based chronic disease management, integrating incentives so that individual patients are not managed as if they had a series of separate chronic diseases. The use of chronic disease registers should be extended across a range of chronic illnesses and used to facilitate audit for quality improvement. Training should focus on clear roles and responsibilities of the team members.
The Chronic Care Model provides a useful framework for understanding the impact of chronic disease management interventions and highlights the gaps in evidence. Consultation with stakeholders and policymakers is valuable in shaping policy options to support the implementation of the National Chronic Disease Strategy in primary care.

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Available from: Gawaine Powell Davies, May 28, 2015
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    • "Weak tie relationships seem to avoid the intense ambivalence and negative sides of feeling/being too dependent on intimate others precisely because it is possible to construct more of a sense of reciprocal exchange. This reciprocity and the potential to offer respite from the negative aspects of intimacy may account for why weak tie relationships have been found to be experienced as less stressful [34], and in the context of self-care they may be more durable and sustainable than other ties. This analysis points to the need to distinguish between strong and weak ties and suggests the need for substantive differentiation of functions and relationships in a self-care context. "
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    Implementation Science 02/2014; 9(1):19. DOI:10.1186/1748-5908-9-19 · 4.12 Impact Factor
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    • "Chronic illness is a significant contributor to the global burden of disease, with markedly increasing prevalence and associated stress on health care systems [1]. In Australia, 80% of the estimated total burden of disease is attributed to chronic illness, primarily cardiovascular disease, chronic respiratory conditions, diabetes and cancer [2]. "
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    BMC Health Services Research 05/2013; 13(1):164. DOI:10.1186/1472-6963-13-164 · 1.71 Impact Factor
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    Iranian journal of nursing and midwifery research 11/2012; 17(7):480-4.
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