实施初级保健计划中的慢性病管理模式（CCM）的优缺点：系统评价。

Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review.

机构信息

School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

School of Public Health, Sun Yat-Sen University, Guangzhou, PR China; General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

出版信息

Int J Cardiol. 2018 May 1;258:279-288. doi: 10.1016/j.ijcard.2017.11.057.

DOI:10.1016/j.ijcard.2017.11.057

PMID:29544944

Abstract

BACKGROUND

Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease.

METHOD AND RESULTS

This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes. We included a total of 25 eligible articles. Evidence of improvement in medical outcomes and the compliance of patients with medical treatment were reported in 18 and 14 studies, respectively. Two studies demonstrated a reduction of the medical burden in terms of health service utilization, and another two studies reported the effectiveness of the programs in reducing the risk of heart failure and other cardiovascular diseases. However, CCMs were still restricted by limited academic robustness and social constraints when they were implemented in primary care. Higher professional recognition, tighter system collaborations and increased financial support may be necessary to overcome the limitations of, and barriers to CCM implementation.

CONCLUSION

This review has identified the benefits of implementing CCM, and recommended suggestions for the future development of CCM.

摘要

背景

慢性照护模式（CCM）旨在通过多维重构医疗体系来改善患者的医疗保健。本系统综述旨在总结和分析专门为实现 CCM 多个组成部分而设计和实施的方案。我们专注于针对糖尿病、高血压和心血管疾病的方案。

方法和结果

本综述基于对 PubMed 数据库中报告临床结果的文章进行全面文献检索。我们共纳入 25 篇符合条件的文章。有 18 项研究报告了医疗结果的改善，14 项研究报告了患者对治疗的依从性。两项研究表明在利用卫生服务方面的医疗负担有所减轻，另外两项研究报告了这些方案在降低心力衰竭和其他心血管疾病风险方面的有效性。然而，当 CCM 在基层医疗中实施时，仍受到学术稳健性和社会限制的限制。为了克服 CCM 实施的局限性和障碍，可能需要更高的专业认可度、更紧密的系统合作和更多的财政支持。