Evaluating a Chronic Disease Management Programme in General Practice: A Comparative Analysis of Healthcare Provider and Patient Perspectives

Fintan Stanley, Mike O'callaghan, Suzanne Kelly, Joe Gallagher, David Mcconaghy, Shane Mckeough

Keywords: chronic disease, reform, evaluation,

Background:

The Health Service Executive (HSE) In Ireland launched a structured Chronic Disease Management (CDM) programme in 2020 to enhance care for older patients with comorbidities in primary care settings with the aim of formalizing and improving chronic disease management.

Research questions:

How has the new CDM programme in Irish primary care settings impacted healthcare providers' (HCPs) perceptions of care quality and workload, and do these perceptions align with patients' experiences and views on self-management and structured care programmes?

Method:

The study investigates the CDM programme through:
1. HCPs perspectives – GPs and practice nurses – on the CDM programme and its impact on patient care, workload, and professional development.
2. Patient experiences, particularly regarding self-management of conditions and their views on the future role of structured care programmes.
For HCPs, a survey was used to gather data on their views and experiences. For patients, a survey administered in GP settings will capture their views.

Results:

Data from 220 HCPs, predominantly from medium-sized practices (2-4 GPs; 72%) in towns (62%), revealed:
• A positive overall impression of the CDM programme (87%).
• 95% noted improvements in patient care quality.
• Increased workload reported by 90%, with 62% experiencing a large increase.
• Thematic analysis of free text responses indicates HCPs are overall positive but have several concerns particularly around workload.

Conclusions:

Initial feedback from healthcare providers indicates a positive reception of the CDM programme, with nearly 9 in 10 approving its impact on enhancing patient care quality. However, 9 in 10 did report an increase in workload, 6 in 10 reporting a large increase, highlighting a major challenge. Future analysis will incorporate patient perspectives to assess alignment with HCP views.

The CDM programme is positively viewed by HCPs for improving patient care, though it significantly increases workload.

Points for discussion:

How to balance improved patient care quality with the increased workloads with new programme rollouts?

Exploring potential strategies to optimize the CDM programmes based on both healthcare provider feedback and patient experiences.

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