Managing chronic conditions in primary care: Best practices and emerging technologies

https://doi.org/10.53730/ijhs.v5nS1.15021

Authors

  • Elham Mohammed Ali Muhanna KSA, National Guard Health Affairs
  • Mohammed Hamed Alqahtani KSA, National Guard Health Affairs

Keywords:

Chronic disease management, integrated care, primary care, technology, patient-centered care, Sláintecare, scoping review

Abstract

Background: Chronic conditions like diabetes, cardiovascular diseases, and COPD are leading global health challenges, contributing significantly to mortality and healthcare costs. Fragmented care services often struggle to meet the complex needs of these patients, making integrated care models a promising approach to improve outcomes and efficiency. Aim: This scoping review aims to explore existing literature on integrated care models for managing chronic conditions, identify best practices and technologies, and pinpoint areas for future research, particularly in alignment with the Irish Sláintecare program. Methods: A scoping review was conducted following Arksey and O’Malley’s framework. The review process involved defining research questions, searching relevant literature, and analyzing data from 22 studies published between 2009 and 2019. Studies were selected based on their relevance to primary care integration and chronic disease management. Results: Integrated care models, including multidisciplinary teams and community-based interventions, have shown promise in improving patient outcomes and cost-effectiveness. Technologies like EHRs and telemedicine facilitate integration by enhancing communication and monitoring. However, results varied, with some studies reporting mixed outcomes related to cost and implementation. Conclusion: Integrated care can enhance chronic disease management but requires ongoing research to address implementation challenges and optimize practices. 

Downloads

Download data is not yet available.

References

Jennings SM. Preventing chronic disease: defining the problem.

Gröne O, Garcia-Barbero M. Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. International journal of integrated care, 2001; 1 DOI: 10.5334/ijic.28

Kodner DL, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications–a discussion paper. International journal of integrated care, 2002; 2 DOI: 10.5334/ijic.67

Armitage GD, Suter E, Oelke ND, Adair CE. Health systems integration: state of the evidence. International journal of integrated care, 2009; 9 DOI: 10.5334/ijic.316

Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care, 2013; 13 DOI: 10.5334/ijic.886

Waddington C, Egger D. Integrated Health Services – What and Why. World Health Organisation; 2008. May 2008. Report No.: Technical Brief No. 1, May 2008.

Boon HS, Mior SA, Barnsley J, Ashbury FD, Haig R. The Difference Between Integration and Collaboration in Patient Care: Results From Key Informant Interviews Working in Multiprofessional Health Care Teams. Journal of Manipulative and Physiological Therapeutics, 2009; 32(9): 715–22. DOI: 10.1016/j.jmpt.2009.10.005

Savage E, Hegarty J, Weathers E, Mulligan L, O’Reilly A, Cronly J, et al. Clinical and Economic Systematic Literature Review to Support the Development of an Integrated Care Programme for Chronic Disease Prevention and Management for the Irish Health System; 2015.

Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. Health Services and Delivery Research, 2018; 6(29). DOI: 10.3310/hsdr06290

Houses of the Oireachtas. Committee on the Future of Healthcare. Sláintecare Report Dublin: Government of Ireland; 2017.

Georghiou T, Keeble E. Age UK’s Personalised Integrated Care Programme.

Daudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol, 2013; 13: 48 DOI: 10.1186/1471-2288-13-48

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005; 8(1): 19–32. DOI: 10.1080/1364557032000119616

Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation science: IS. 52010. p. 69.

Donaldson MS, Yordy KD, Lohr KN, Vanselow NA. Primary care: America’s health in a new era: National Academies Press; 1996.

Aromataris E, Riitano D. Constructing a search strategy and searching for evidence. A guide to the literature search for a systematic review. The American journal of nursing, 2014; 114(5): 49–56. DOI: 10.1097/01.NAJ.0000446779.99522.f6

Pham MT, Rajic A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research synthesis methods, 2014; 5(4): 371–85. DOI: 10.1002/jrsm.1123

Hollingworth SA, Donald M, Zhang J, Vaikuntam BP, Russell A, Jackson C. Impact of a general practitioner-led integrated model of care on the cost of potentially preventable diabetes-related hospitalisations. Primary care diabetes, 2017; 11(4): 344–7. DOI: 10.1016/j.pcd.2017.03.009

Eggers C, Dano R, Schill J, Fink G, Hellmich M, Timmermann L, et al. Patient-centered integrated healthcare improves quality of life in Parkinson’s disease patients: a randomized controlled trial. Journal of neurology, 2018; 265(4): 764–73. DOI: 10.1007/s00415-018-8761-7

Kruis AL, van Adrichem J, Erkelens MR, Scheepers H. Sustained effects of integrated COPD management on health status and exercise capacity in primary care patients. International journal of chronic obstructive pulmonary disease, 2010; 5: 407 DOI: 10.2147/COPD.S9654

Kruis AL, Boland MR, Assendelft WJ, Gussekloo J, Tsiachristas A, Stijnen T, et al. Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial. bmj, 2014; 349: g5392 DOI: 10.1136/bmj.g5392

Fortin M, Chouinard M-C, Dubois M-F, Bélanger M, Almirall J, Bouhali T, et al. Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC). CMAJ open, 2016; 4(4): E588 DOI: 10.9778/cmajo.20160031

Zhang J, Donald M, Baxter K, Ware R, Burridge L, Russell A, et al. Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus. Diabetic Medicine, 2015; 32(7): 872–80. DOI: 10.1111/dme.12705

Boland MR, Kruis AL, Tsiachristas A, Assendelft WJ, Gussekloo J, Blom CM, et al. Cost-effectiveness of integrated COPD care: the RECODE cluster randomised trial. BMJ open, 2015; 5(10): e007284. DOI: 10.1136/bmjopen-2014-007284

Ferrone M, Masciantonio MG, Malus N, Stitt L, O’Callahan T, Roberts Z, et al. The impact of integrated disease management in high-risk COPD patients in primary care. NPJ primary care respiratory medicine. 2019; 29(1): 8. DOI: 10.1038/s41533-019-0119-9

Busetto L, Luijkx K, Huizing A, Vrijhoef B. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study. BMC family practice. 2015; 16(1): 105 DOI: 10.1186/s12875-015-0320-z

Hernandez C, Alonso A, Garcia-Aymerich J, Grimsmo A, Vontetsianos T, Cuyàs FG, et al. Integrated care services: lessons learned from the deployment of the NEXES project. International journal of integrated care, 2015; 15 DOI: 10.5334/ijic.2018

van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, et al. Integrated multidisciplinary care in Parkinson’s disease: a non-randomised, controlled trial (IMPACT). The Lancet Neurology, 2013; 12(10): 947–56. DOI: 10.1016/S1474-4422(13)70196-0

Waibel S, Vargas I, Aller M-B, Gusmão R, Henao D, Vázquez ML. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients. International journal of integrated care, 2015; 15 DOI: 10.5334/ijic.1527

Russell A, Baxter K, Askew D, Tsai J, Ware R, Jackson C. Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabetic Medicine, 2013; 30(9): 1112–21. DOI: 10.1111/dme.12251

Russell AW, Donald M, Borg SJ, Zhang J, Burridge LH, Ware RS, et al. Clinical outcomes of an integrated primary–secondary model of care for individuals with complex type 2 diabetes: a non-inferiority randomised controlled trial. Diabetologia, 2019; 62(1): 41–52. DOI: 10.1007/s00125-018-4740-x

Hanan T, Mullen L, Laffoy M, O’Toole E, Richmond J, Wynne M. Delivering care to oncology patients in the community: an innovative integrated approach. British journal of community nursing, 2014; 19(8): 382–7. DOI: 10.12968/bjcn.2014.19.8.382

Oude SW, Lingsma H, Ketelaars C, Mackenbach J, Robben P. Effects of government supervision on quality of integrated diabetes care: a cluster randomized controlled trial. Nederlands tijdschrift voor geneeskunde, 2016; 160: A9862–A.

Browne JL, Speight J, Martin C, Gilfillan C. Building the evidence for integrated care for type 2 diabetes: a pilot study. Australian journal of primary health, 2016; 22(5): 409–15. DOI: 10.1071/PY15020

Yu D, Yang W, Cai Y, Zhao Z, Simmons D. Population-level impact of diabetes integrated care on commissioner payments for inpatient care among people with type 2 diabetes in Cambridgeshire: a postintervention cohort follow-up study. BMJ open, 2017; 7(12): e015816 DOI: 10.1136/bmjopen-2017-015816

Simmons D, Yu D, Bunn C, Cohn S, Wenzel H, Prevost T. Hospitalization among patients with diabetes associated with a Diabetes Integrated Care Initiative: a mixed methods case study. Future hospital journal, 2015; 2(2): 92–8. DOI: 10.7861/futurehosp.2-2-92

Burridge L, Foster M, Donald M, Zhang J, Jackson C. The work of local healthcare innovation in primary care: a qualitative study of GP-led integrated diabetes care; 2015.

Hepworth J, Askew D, Jackson C, Russell A. ‘Working with the team’: an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care. Australian journal of primary health, 2013; 19(3): 207–12. DOI: 10.1071/PY12087

Burridge LH, Foster MM, Donald M, Zhang J, Russell AW, Jackson CL. A qualitative follow-up study of diabetes patients’ appraisal of an integrated diabetes service in primary care. Health & social care in the community, 2017; 25(3): 1031–40. DOI: 10.1111/hsc.12402

World Medical Association. WMA Statement on the Global Burden of Chronic Disease Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, 2011; 62.

Murtagh, S., McCombe, G., Broughan, J., Carroll, Á., Casey, M., Harrold, Á., ... & Cullen, W. (2021). Integrating primary and secondary care to enhance chronic disease management: a scoping review. International journal of integrated care, 21(1).

Published

15-01-2021

How to Cite

Muhanna, E. M. A., & Alqahtani, M. H. (2021). Managing chronic conditions in primary care: Best practices and emerging technologies. International Journal of Health Sciences, 5(S1), 970–982. https://doi.org/10.53730/ijhs.v5nS1.15021

Issue

Section

Peer Review Articles