Congruency of diabetes care with the Chronic Care Model in different Swiss health care organisations from the patients’ perspective: A cross sectional study
QUESTIONS UNDER STUDY: Patients with chronic illnesses like diabetes mellitus benefit from care following the concept of the Chronic Care Model. To improve quality and to be responsive to patients’ needs reliable data on patients’ view of care in different healthcare settings are required. We evaluated the congruency of diabetes care with the Chronic Care Model between managed and non-managed care organisations from a patient’s perspective.
METHODS: We compared type 2 diabetes patients from non-managed care with a managed care organisation in Switzerland. We evaluated differences between these settings with the Patient Assessment of Chronic Illness Care 5A questionnaire (PACIC 5A; scale from 1–5) that combines the PACIC and the 5A-approach of physicians’ counselling.
RESULTS: 374 patients completed the PACIC 5A (326 from non-managed care settings, 48 from managed care). The adjusted average PACIC summary score was 3.18 in the non-managed care compared to 3.49 in the managed care sample (p = 0.046). Managed care patients scored significantly higher in the subscales goal setting (2.86 vs 3.29; p = 0.015), advice (3.23 vs 3.64; p = 0.014), assist (2.98 vs 3.44; p = 0.016) and arrange (2.50 vs 2.88; p = 0.049).
CONCLUSIONS: Our data from different health care settings suggest that managed care is recognised by type 2 diabetes patients as care that is more congruent with the Chronic Care Model and offers more intense behavioural counselling and self-management support compared with usual primary care in Switzerland. Future research should evaluate larger, more comparable patient groups.
- Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.
- Improving Chronic Illness Care (ICIC). http://www.improvingchroniccare.org/.
- Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Heal ServRes. 2002;37(3):791–820.
- Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005;43(5):436–44.
- Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J. Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pr. 2007;13(5):806–13.
- Steurer-Stey C, Frei A, Schmid-Mohler G, Malcolm-Kohler S, Zoller M, Rosemann T. Assessment of Chronic Illness Care with the German version of the ACIC in different primary care settings in Switzerland. Heal Qual Life Outcomes. 2010;8:122.
- Frei A, Chmiel C, Schlapfer H, Birnbaum B, Held U, Steurer J, et al. The Chronic CARe for diAbeTes study (CARAT): a cluster randomized controlled trial. Cardiovasc Diabetol. 2010;9:23.
- Frei A, Herzog S, Woitzek K, Held U, Senn O, Rosemann T, et al. Characteristics of poorly controlled Type 2 diabetes patients in Swiss primary care. Cardiovasc Diabetol. 2012;11:70.
- American Diabetes Association. Standards of medical care in diabetes – 2011. Diabetes Care. 2011;34(Suppl 1):S11–61.
- Goldstein MG, Whitlock EP, DePue J. Multiple behavioral risk factor interventions in primary care. Summary of research evidence. Am J Prev Med. 2004;27(2 Suppl):61–79.
- Glasgow RE, Whitesides H, Nelson CC, King DK. Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients: relationship to patient characteristics, receipt of care, and self-management. Diabetes Care. 2005;28(11):2655–61.
- Szecsenyi J, Rosemann T, Joos S, Peters-Klimm F, Miksch A. German Diabetes Disease Management Programs Are Appropriate for Restructuring Care According to the Chronic Care Model: An evaluation with the Patient Assessment of Chronic Illness Care instrument. Diabetes Care. 2008;31(6):1150–4.
- Grol R, Wensing M, Mainz J, Ferreira P, Hearnshaw H, Hjortdahl P, et al. Patients’ priorities with respect to general practice care: an international comparison. European Task Force on Patient Evaluations of General Practice (EUROPEP). FamPract. 1999;16(1):4–11.
- Klingenberg A, Bahrs O, Szecsenyi J. [How do patients evaluate general practice? German results from the European Project on Patient Evaluation of General Practice Care (EUROPEP)]. Z ArztlFortbildQualitatssich. 1999;93(6):437–45.
- Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288(15):1909–14.
- Glasgow RE, Bull SS, Gillette C, Klesges LM, Dzewaltowski DA. Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity. Am J Prev Med. 2002;23(1):62–9.
- Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management. Jt Comm J Qual Saf. 2003;29(11):563–74.
- Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.
- Steurer-Stey C, Fletcher M, Vetter W, Steurer J. Patient education in asthma: a survey of physicians’ knowledge of the principles and implementation of self management in practice. Swiss Med Wkly. 2006;136(35–36):561–5.
- Burgmann K, Fatio S, Jordi B, Rutishauser J. Medical care of type 2 diabetes mellitus in light of international and national recommendations: a retrospective analysis. Swiss Med Wkly. 2013;143:w13871.
- Clark NM, Gong M. Management of chronic disease by practitioners and patients: are we teaching the wrong things? BMJ. 2000;320(7234):572–5.
- Wennberg JE. Time to tackle unwarranted variations in practice. BMJ. 2011;342:687–90.