Applying the Chronic Care Model (Part 2)

Let's briefly review what we covered in the previous modules. The chronic care model identifies the six essential elements of a healthcare system that encourage high quality chronic disease care. These elements are self-management support, delivery system design, decision support, clinical information systems, the health system and community resources. The Chronic Care Model is clinically oriented while the Expanded Chronic Care Model is public health oriented.

Both emphasize the importance of community care and self-management support and provide a framework for system and organizational change. The Expanded Chronic Care Model emphasizes community participation in planning, implementing and evaluating programs and policies and in identifying and addressing barriers to optimum health and health care.

Chronic Care Model identifies patient centeredness, effectiveness, efficiency, equity, and timeliness, as essential elements of efficient health service delivery for people with chronic illness. Patient centeredness in health care has been shown to increase patient engagement, satisfaction and compliance, improve quality of life and reduce patient anxiety. Prevention and control of chronic conditions can be approached more effectively by offering a patient centered care approach, rather than focusing on the disease. Patient centered care involves ensuring the accessibility and continuity of care, strengthening patient involvement in care so that it is easier for patients to express their concerns; and it allows healthcare service providers to respect their patient's values, preferences and needs and offer emotional support especially to relieve their anxieties and fears. It also supports self-management across all levels of the system by facilitating therapeutic goal setting and boosting the confidence of patients and their families in self-care. Patient centered care involves establishing more efficient mechanisms for inter-unit coordination and integration. It also means that health network staff are aware of these principles and appropriately trained to offer this type of care, which may include bringing in community resources.

Barriers to implementing the chronic care model can include barriers related to executing intervention processes, as implementing the multiple components of the chronic care model into practice creates additional responsibilities for staff who are limited by time constraints, sustainability of the interventions can be difficult in some instances. Staff buying is a very important aspect of implementation to ensure program longevity. Many studies found that execution of the intervention processes was challenging without support and accountability from senior leadership. Characteristics of the healthcare organization can be another barrier. The size of the organization whether it has adopted a team-based approach can influence the success of CCM adoption. institutional factors such as staff turnover results in an increased burden of responsibilities on existing providers, and leadership turnover is a barrier towards implementing care change processes. organizational readiness for the CCM was found to be impacted by the lack of interest and commitment from leadership and on availability of resources for implementation. Lack of resources that influence readiness included low funding, lack of Provider Reimbursement strategies, and low staff numbers. Without the presence of an intervention champion endorsement of the CCM initiative was found to be limited provider by and was greatly influenced by knowledge and beliefs about intervention, particularly they had misconceptions were unconvinced officer effectiveness, or lacked information. Acceptance of the interventions by clinicians required time and was also affected by the workload associated with implementing and executing the intervention components.