Introduction

1. Integrated Chronic Disease Management in Primary/Secondary Care: A Systematic Review Martin Connor1, David Lim2, Lauren Ward1, Julie Hepworth2 1 Centre for Health Innovation, Griffith University 2 School of Public Health and Social Work, Queensland University of Technology Introduction Chronic disease accounted for 90% of all deaths in 2011 [1] • Type 2 diabetes has traditionally been managed as a single chronic disease state but it can commonly exist with co-morbidities such as depression. • Treatment is multifaceted, requiring both primary and secondary care, however, health service delivery is often fragmented. • Integrated chronic disease management is a growing model of interest underpinned by the Chronic Care Model (CCM) [2]. • The CCM identifies six key elements for effective care, and has shown promise in improving the management of diabetes. Delivery System Design Clinical Information Systems CHRONIC CARE MODEL ELEMENTS Health Care Organisation Community Linkages Aim Decision Support Self-management support To investigate the effectiveness of integrated chronic disease management interventions across primary/secondary care. Methods • A systematic review of peer reviewed literature from PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs was conducted. • Studies were included that met the following criteria: Published in English, date range between 2004-2014, primary/secondary implementation, and interventions managing chronic disease. Results Figure 1. Stages of the literature search process Total citations identified by search: N= 953 • Fifty-one studies met the inclusion criteria: US (38), Australia (5), UK (2), Canada (2), Netherlands (1), Norway (1), Ireland (1), multi-country (1). • Interventions adopted at least one (x 4) element of the CCM, with the majority implementing delivery system redesign activities within primary care practice. • Interventions significantly reduced ED and hospital admissions, improved patient health outcomes such as HbA1c, and reduced costs. Table 1. Mean Differences of Key Outcome Measures Duplicates: N= 175 Not English: N= 3 Included Papers: N= 775 Excluded by abstract and title: N= 611 Passed title and abstract screen. Full manuscripts obtained and reviewed for inclusion: N= 164 • Excluded (N= 135) • Reasons for exclusion: • Emailed author N= 6 • Not specifically evaluating integrated care N= 44 • Not primary/secondary integrated intervention N= 11 • Opinions about integrated care N= 47 • Paediatrics N= 12 • Not primary study N= 14 • Not Chronic Disease • N= 1 Passed full text screening and included in review: N= 29 Snowball papers retrieved N = 30 Excluded N= 8 (Subject to exclusion criteria above) Included papers: N= 51 Conclusions “The current challenge is to be specific about what integrated services look like – what are the key functions which need to be developed?”[3] • Integrated chronic disease management interventions have numerous definitions and components. • Integrated care interventions involving elements of the CCM positively impacted service utilisation, patients outcomes and costs. • Preliminary analysis indicates that the adoption of all CCM elements may not be necessary to improve clinical outcomes and cost effectiveness. References 1 Australian Institute of Health and Welfare. Australia’s health 2014: Australia’s health series no. 14. Canberra: AIHW; 2014 [cited 2014 August 10]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547726 2 Bodenheimer T., Wagner EH., & Grumbach K. Improving Primary Care for Patients with Chronic Illness. JAMA. 2002; 288(14):1775-9 3 World Health Organisation. Integrated Health Services- What and Why? Making Health Systems Work. Technical Brief No. 1. Geneva: WHO; 2008. [cited 2014 August 10]. Available from : http://www.who.int/healthsystems/service_delivery_techbrief1.pdf