Kadu Mudathira K, Stolee Paul
School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada.
BMC Fam Pract. 2015 Feb 6;16:12. doi: 10.1186/s12875-014-0219-0.
The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation.
This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation.
This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs.
These findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers' and organizational perspective.
慢性病照护模式（CCM）是一个为重新设计基层医疗中慢性病患者的护理服务而开发的框架。CCM及其各个组成部分已被广泛采用和评估，然而，对于其实施过程中的不同基层医疗经验以及影响其成功采用的因素，我们知之甚少。本综述的目的是综合在基层医疗中实施CCM的研究结果，以确定实施过程中遇到的促进因素和障碍。
本研究检索了英文的、同行评审的研究文章，这些文章描述了基层医疗环境中的CCM。在三个数据库中进行了检索：Web of Knowledge、Pubmed和Scopus。根据文章摘要和标题是否符合以下纳入标准进行阅读：1）2003年后发表的描述或评估CCM实施情况的研究；2）护理环境为基层医疗；3）研究的目标人群是18岁以上患有慢性病的成年人。研究按照参考文献、研究设计和方法、参与者和环境、研究目标、使用的CCM组件以及干预描述进行分类。数据提取的下一阶段涉及使用研究实施整合框架对引用的障碍和促进因素进行定性分析。
本综述在22项研究中确定了不同基层医疗环境中实施CCM的障碍和促进因素。主要出现的主题与组织的内部环境、实施过程以及个体医疗服务提供者的特征有关。这些包括：组织文化、其结构特征、网络和沟通、实施氛围和准备情况、支持性领导的存在以及提供者的态度和信念。
这些发现强调了在实施CCM之前和期间评估组织能力和需求的重要性，以及更好地理解医疗服务提供者和组织的观点的重要性。
