The co-occurrence of two or more chronic conditions within one person is continuously growing. Currently, healthcare is mostly characterized by fragmented interventions frequently addressing single chronic diseases. Chronic Care Model (CCM) is the forefather of disease management programs (DMPs) developed to deliver to chronic patients coordinated healthcare among several health services. A systematic review was carried out in order to evaluate the impact of Chronic Care Model determinants addressing patients with multiple chronic conditions. Methods The search was conducted by querying electronic databases and hand searching. Only studies concerning interventions belonging to structured health plan and addressing adults patients with long-term multiple chronic conditions were selected. Studies were divided in two groups depending on the inclusion of depression as comorbidity and in further subgroups according to the CCM dimensions interested. To describe the impact of CCM dimensions and to grade the strength of recommendations, the outcomes of the studies were grouped in macro-categories according to thematic topics. Results 12 studies (8 trials and 4 observational) out of 7807 were included. The total sample regarded 57713 subjects. Years of publication were comprised from 2002 to 2012. 8 studies were set in USA and 4 in Germany, The Netherlands, Finland and Canada. Interventions attributable to Delivery System Design (DSD) and Self Management Support (SMS) as CCM dimensions were represented in all the selected studies. A positive impact on outcomes was observed in the subgroup including DSD, SMS and Clinical Information System (CIS) addressing depression and in the subgroup not addressing depression but including all the six CCM dimensions. Conclusions Delivering coordinated interventions attributable to minimum three CCM dimensions (DSD, SMS, CIS) seem to have a positive impact on healthcare addressing multimorbid patients. Key messages Our research contributes to the debate on which healthcare interventions address multimorbid patients Health plans addressing multi-chronic patients include interventions attributable to Delivery System Design and Self Management Support as Chronic Care Model (CCM) dimensions
Frisicale, E. M., De Vito, C., Silvestrini, G., Rega, M. L., Acampora, A., Galletti, C., Villari, P., Ricciardi, W., Damiani, G., Impact of Chronic Care Model determinants in multimorbid patients health plans: a systematic review, Abstract de <<8th European Public Health Conference – “Health in Europe – from global to local policies, methods and practices”>>, (Milano, 14-17 October 2015 ), <<EUROPEAN JOURNAL OF PUBLIC HEALTH>>, 2015; 25 (Suppl. 3) (N/A): 174-174 [http://hdl.handle.net/10807/69275]
Impact of Chronic Care Model determinants in multimorbid patients health plans: a systematic review
Frisicale, Emanuela Maria;Silvestrini, Giulia;Rega, Maria Luisa;Acampora, Anna;Galletti, Caterina;Villari, Paolo;Ricciardi, Walter;Damiani, Gianfranco
2015
Abstract
The co-occurrence of two or more chronic conditions within one person is continuously growing. Currently, healthcare is mostly characterized by fragmented interventions frequently addressing single chronic diseases. Chronic Care Model (CCM) is the forefather of disease management programs (DMPs) developed to deliver to chronic patients coordinated healthcare among several health services. A systematic review was carried out in order to evaluate the impact of Chronic Care Model determinants addressing patients with multiple chronic conditions. Methods The search was conducted by querying electronic databases and hand searching. Only studies concerning interventions belonging to structured health plan and addressing adults patients with long-term multiple chronic conditions were selected. Studies were divided in two groups depending on the inclusion of depression as comorbidity and in further subgroups according to the CCM dimensions interested. To describe the impact of CCM dimensions and to grade the strength of recommendations, the outcomes of the studies were grouped in macro-categories according to thematic topics. Results 12 studies (8 trials and 4 observational) out of 7807 were included. The total sample regarded 57713 subjects. Years of publication were comprised from 2002 to 2012. 8 studies were set in USA and 4 in Germany, The Netherlands, Finland and Canada. Interventions attributable to Delivery System Design (DSD) and Self Management Support (SMS) as CCM dimensions were represented in all the selected studies. A positive impact on outcomes was observed in the subgroup including DSD, SMS and Clinical Information System (CIS) addressing depression and in the subgroup not addressing depression but including all the six CCM dimensions. Conclusions Delivering coordinated interventions attributable to minimum three CCM dimensions (DSD, SMS, CIS) seem to have a positive impact on healthcare addressing multimorbid patients. Key messages Our research contributes to the debate on which healthcare interventions address multimorbid patients Health plans addressing multi-chronic patients include interventions attributable to Delivery System Design and Self Management Support as Chronic Care Model (CCM) dimensions
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