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A systematic review of chronic disease management interventions in primary care

BACKGROUND: Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings. ME...

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Autores principales: Reynolds, Rebecca, Dennis, Sarah, Hasan, Iqbal, Slewa, Jan, Chen, Winnie, Tian, David, Bobba, Sangeetha, Zwar, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759778/
https://www.ncbi.nlm.nih.gov/pubmed/29316889
http://dx.doi.org/10.1186/s12875-017-0692-3
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author Reynolds, Rebecca
Dennis, Sarah
Hasan, Iqbal
Slewa, Jan
Chen, Winnie
Tian, David
Bobba, Sangeetha
Zwar, Nicholas
author_facet Reynolds, Rebecca
Dennis, Sarah
Hasan, Iqbal
Slewa, Jan
Chen, Winnie
Tian, David
Bobba, Sangeetha
Zwar, Nicholas
author_sort Reynolds, Rebecca
collection PubMed
description BACKGROUND: Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings. METHODS: The methods were based on our previous review published in 2006. We performed database searches for articles published from 2006 to 2014 and conducted a systematic review with narrative synthesis using the Cochrane Effective Practice and Organisation of Care taxonomy to classify interventions and outcomes. The interventions were mapped to Chronic Care Model elements. The pattern of outcomes related to interventions was summarized by frequency of statistically significant improvements in health care provision and patient outcomes. RESULTS: A total of 9589 journal articles were retrieved from database searches and snowballing. After screening and verification, 165 articles that detailed 157 studies were included. There were few studies with Health Care Organization (1.9% of studies) or Community Resources (0.6% of studies) as the primary intervention element. Self-Management Support interventions (45.8% of studies) most frequently resulted in improvements in patient–level outcomes. Delivery System Design interventions (22.6% of studies) showed benefits in both professional and patient-level outcomes for a narrow range of conditions. Decision Support interventions (21.3% of studies) had impact limited to professional-level outcomes, in particular use of medications. The small number of studies of Clinical Information System interventions (8.9%) showed benefits for both professional- and patient-level outcomes. CONCLUSIONS: The published literature has expanded substantially since 2006. This review confirms that Self-Management Support is the most frequent Chronic Care Model intervention that is associated with statistically significant improvements, predominately for diabetes and hypertension. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-017-0692-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-57597782018-01-16 A systematic review of chronic disease management interventions in primary care Reynolds, Rebecca Dennis, Sarah Hasan, Iqbal Slewa, Jan Chen, Winnie Tian, David Bobba, Sangeetha Zwar, Nicholas BMC Fam Pract Research Article BACKGROUND: Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings. METHODS: The methods were based on our previous review published in 2006. We performed database searches for articles published from 2006 to 2014 and conducted a systematic review with narrative synthesis using the Cochrane Effective Practice and Organisation of Care taxonomy to classify interventions and outcomes. The interventions were mapped to Chronic Care Model elements. The pattern of outcomes related to interventions was summarized by frequency of statistically significant improvements in health care provision and patient outcomes. RESULTS: A total of 9589 journal articles were retrieved from database searches and snowballing. After screening and verification, 165 articles that detailed 157 studies were included. There were few studies with Health Care Organization (1.9% of studies) or Community Resources (0.6% of studies) as the primary intervention element. Self-Management Support interventions (45.8% of studies) most frequently resulted in improvements in patient–level outcomes. Delivery System Design interventions (22.6% of studies) showed benefits in both professional and patient-level outcomes for a narrow range of conditions. Decision Support interventions (21.3% of studies) had impact limited to professional-level outcomes, in particular use of medications. The small number of studies of Clinical Information System interventions (8.9%) showed benefits for both professional- and patient-level outcomes. CONCLUSIONS: The published literature has expanded substantially since 2006. This review confirms that Self-Management Support is the most frequent Chronic Care Model intervention that is associated with statistically significant improvements, predominately for diabetes and hypertension. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-017-0692-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-01-09 /pmc/articles/PMC5759778/ /pubmed/29316889 http://dx.doi.org/10.1186/s12875-017-0692-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Reynolds, Rebecca
Dennis, Sarah
Hasan, Iqbal
Slewa, Jan
Chen, Winnie
Tian, David
Bobba, Sangeetha
Zwar, Nicholas
A systematic review of chronic disease management interventions in primary care
title A systematic review of chronic disease management interventions in primary care
title_full A systematic review of chronic disease management interventions in primary care
title_fullStr A systematic review of chronic disease management interventions in primary care
title_full_unstemmed A systematic review of chronic disease management interventions in primary care
title_short A systematic review of chronic disease management interventions in primary care
title_sort systematic review of chronic disease management interventions in primary care
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759778/
https://www.ncbi.nlm.nih.gov/pubmed/29316889
http://dx.doi.org/10.1186/s12875-017-0692-3
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