A Qualitative Study of the Relationship between Clinician Attributes, Organization, and Patient Characteristics on Implementation of a Disease Management Program
Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, Ontario, Canada.Disease Management (Impact Factor: 1.39). 05/2008; 11(2):129-37. DOI: 10.1089/dis.2008.1120008
The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices.
- [Show abstract] [Hide abstract]
ABSTRACT: Asthma is one of the most common chronic diseases of adults and children in industrialized countries, and has had a marked increase in prevalence over the past 25 years. Asthma disproportionately affects under-represented minority populations, with African Americans and (some) Hispanics having higher rates than other groups. Racial and ethnic disparities in asthma prevalence and severity exist and are partially explained by environmental, social, cultural, and economic factors. Genetic factors also clearly affect an individual's susceptibility to asthma. Numerous strategies to reduce disparities surrounding asthma incidence, morbidity, and mortality have been proposed, and a few of them are highlighted in this article. However, as a whole, these strategies have done little to reduce ethnic disparities in asthma-related morbidity. Case detection and prescription of appropriate therapy, particularly the prescription of inhaled corticosteroids, are essential but not sufficient to improve outcomes. Family and patient-centered asthma education and culturally focussed approaches in communities who share common belief sets have been shown to reduce asthma symptom days and to improve functional health status; however, most strategies have incorporated interventions to improve therapy in addition to patient education, making it difficult to determine which component (improved therapy, patient education, or both) has resulted in the improved outcomes. Language concordance and the field testing of patient materials are important for the success of educational programs, while the setting of the education (emergency departments, hospitals, communities, or schools) does not seem as important as the intervention itself. The quality of the patient-physician interaction and the cultural and cross-cultural competence of the clinician are also important factors capable of reducing disparities in the asthma care provided to minority populations and women, while the effectiveness of environmental control strategies in reducing asthma morbidity, especially in urban-dwelling, low socioeconomic groups, has had conflicting results. While there have been reasonably few community-level interventions, these interventions have been adapted to the ethnic, social, and economic characteristics of specific populations and may hold promise in the future. At the present time, interventions that improve asthma diagnosis, increase the appropriate use of inhaled corticosteroid therapy, and assure access to medication in the context of a family-centered, community-based, culturally-appropriate intervention hold the greatest promise of reducing disparities in asthma morbidity and mortality in ethnically and socioeconomically diverse populations. In all likelihood, there is no single intervention that will reduce the especially high asthma burden in minority populations. Large-scale, cost-effective, systematic, standardized approaches that are relevant to populations and are culturally, socially, and economically diverse are needed.Disease Management and Health Outcomes 01/2008; 16(2):95-105. DOI:10.2165/00115677-200816020-00004 · 0.35 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Disease management has gained popularity as a way to improve health status and control of chronic illness through the use of risk stratification, targeted nurse outreach, telephonic nurse advice, and evidence-based guidelines in managing illness. Disease management programs have been successfully implemented by commercial insurers and managed care plans, as well as in Medicare and state Medicaid programs. Although evidence regarding cost savings is inconsistent, it appears that disease management programs do impact health status and quality of care, and improve self-management among the chronically ill. Disease management programs can be customized to meet the needs of vulnerable subpopulations. This article explores the barriers to dealing with chronic illness and other factors faced by disease management programs for Medicaid populations. Barriers to participation and success in disease management for Medicaid beneficiaries are apparent due to lack of access to translation and interpretation services; difficulty with community outreach; achieving buy in from providers and beneficiaries; problems with housing; difficulties accessing primary and specialty care; problems with the availability of pharmacy, durable medical equipment, and other support services; as well as difficulties with Medicaid eligibility and In order to create a successful disease management program that positively impacts health status, utilization, and cost, it is necessary to consider all of these barriers when designing an intervention for Medicaid beneficiaries. Some of the innovative ways to handle the difficulties of dealing with Medicaid or other low-income populations with special healthcare needs include expanded interpretation and translation activities, extensive community outreach to patients and safety net providers such as clinics and public hospitals, providing support services related to non-medical problems experienced by enrollees, providing understandable written and verbal instructions and training related to health education and medication adherence, as well as efforts to track and maintain contact with eligible and enrolled individuals. Disease management programs can be successful in saving money and improving health in Medicaid populations. However, they must be carefully designed with the specific state Medicaid program and should target the needs of the state DOI: 10.2165/0115677-200816060-00007Disease Management and Health Outcomes 01/2008; 16(6):421-428. DOI:10.2165/0115677-200816060-00007 · 0.35 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In recent years, there has been a growing understanding that organizational culture is related to an organization's performance. However, few studies have examined organizational culture in medical group practices. The purpose of this study was to examine the relationship of organizational culture on provider job satisfaction and perceived clinical effectiveness in primary care pediatric practices. This cross-sectional study included 36 primary care pediatric practices located in Connecticut. There were 374 participants in this study, which included 127 clinicians and 247 nonclinicians. Office managers completed a questionnaire that recorded staff and practice characteristics; all participants completed the Organizational Culture Scale, a questionnaire that assessed the practice on four cultural domains (i.e., group, developmental, rational, and hierarchical), and the Primary Care Organizational Questionnaire that evaluated perceived effectiveness and job satisfaction. Hierarchical linear models using a restricted maximum likelihood estimation method were used to evaluate whether the practice culture types predicted job satisfaction and perceived effectiveness. Group culture was positively associated with both satisfaction and perceived effectiveness. In contrast, hierarchical and rational culture were negatively associated with both job satisfaction and perceived effectiveness. These relationships were true for clinicians, nonclinicians, and the practice as a whole. Our study demonstrates that practice culture is associated with job satisfaction and perceived clinical effectiveness and that a group culture was associated with high job satisfaction and perceived effectiveness.Health care management review 10/2010; 35(4):365-71. DOI:10.1097/HMR.0b013e3181edd957 · 1.30 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.