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. 2018 Jan 9;19(1):11.
doi: 10.1186/s12875-017-0692-3.

A systematic review of chronic disease management interventions in primary care

Rebecca Reynolds  1 , Sarah Dennis  2 , Iqbal Hasan  1 , Jan Slewa  1 , Winnie Chen  1 , David Tian  1 , Sangeetha Bobba  1 , Nicholas Zwar  3   4
Affiliations

A systematic review of chronic disease management interventions in primary care

Rebecca Reynolds et al. BMC Fam Pract. .

Abstract

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.

Keywords: Arthritis; Cardiovascular; Chronic care; Diabetes; Disease management/care management; Endocrinology; Musculoskeletal/connective tissue; Respiratory system; Systematic review.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable as the article is a systematic review.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Chronic Care Model
Fig. 2
Fig. 2
Prisma flow diagram
See this image and copyright information in PMC

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