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. 2024 Dec;30(1):2343364.
doi: 10.1080/13814788.2024.2343364. Epub 2024 May 13.

Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands

Esther A Boudewijns  1 , Danny Claessens  1 , Onno C P van Schayck  1 , Mascha Twellaar  1 , Bjorn Winkens  2 , Manuela A Joore  3 , Lotte C E M Keijsers  1 , Stijn Krol  1 , Mathijs Urlings  1 , Annerika H M Gidding-Slok  1
Affiliations

Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands

Esther A Boudewijns et al. Eur J Gen Pract. 2024 Dec.

Abstract

Background: The Assessment of Burden of Chronic Conditions (ABCC)-tool was developed to optimise chronic care.

Objectives: This study aimed to assess the effectiveness of the ABCC-tool in patients with COPD, asthma, type 2 diabetes, and/or heart failure in primary care in the Netherlands.

Methods: The study had a pragmatic, clustered, two-armed, quasi-experimental design. The intervention group (41 general practices; 176 patients) used the ABCC-tool during routine consultations and the control group (14 general practices; 61 patients) received usual care. The primary outcome was a change in perceived quality of care (PACIC; Patient Assessment of Chronic Illness Care) after 18 months. Secondary outcomes included change in the PACIC after 6 and 12 months, and in quality of life (EQ-5D-5L; EuroQol-5D-5L), capability well-being (ICECAP-A; ICEpop CAPability measure for Adults), and patients' activation (PAM; Patient Activation Measure) after 6, 12, and 18 months for the total group and conditions separately.

Results: We observed a significant difference in the PACIC after 6, 12, and 18 months (18 months: 0.388 points; 95%CI: 0.089-0.687; p = 0.011) for the total group and after 6 and 12 months for type 2 diabetes. After 18 months, we observed a significant difference in the PAM for the total group but not at 6 and 12 months, and not for type 2 diabetes. All significant effects were in favour of the intervention group. No significant differences were found for the EQ-5D-5L and the ICECAP-A.

Conclusion: Use of the ABCC-tool has a positive effect on perceived quality of care and patients' activation, which makes the tool ready for use in clinical practice. Healthcare providers (e.g. general practitioners and practice nurses) can use the tool to provide person-centred care.Trial registration number: ClinicalTrials.gov Registry (NCT04127383).

Keywords: Chronic conditions; general practice; person-centred care; self-management; shared decision making.

Plain language summary

The Assessment of Burden of Chronic Conditions (ABCC)-tool aims to support disease management for one or multiple chronic condition(s), currently COPD, asthma, type 2 diabetes, and heart failure.Statistically significant differences in patients’ perceived quality of care and patient activation were found between the group that used the ABCC-tool and the care-as-usual group. No effect was found on generic quality of life or capability well-being.Healthcare providers can use the ABCC-tool in primary care.

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Conflict of interest statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1.
Figure 1.
Visualisation of the ABCC-tool for a person with COPD and type 2 diabetes.
Figure 2.
Figure 2.
Flowchart of patients in the study. IC = informed consent; LTFU = lost to follow-up. *not completed: questionnaire was sent to participant, but participant did not complete the questionnaire. The participant was not lost-to-follow-up. ǂe.g. takes too much time or effort, too complicated, not able to participate due to other illness. ×The questionnaire was not sent to a participant because the study stopped before the participant reached this follow-up point).
Figure 3.
Figure 3.
Mean change in PACIC total scores at 6, 12, and 18-month follow-up compared with baseline for the total group. The whiskers show the 95% confidence intervals.
See this image and copyright information in PMC

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