scholarly journals Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Shantanu Nundy ◽  
Jonathan J. Dick ◽  
Anna P. Goddu ◽  
Patrick Hogan ◽  
Chen-Yuan E. Lu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Health Plan ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Primary Care Team ◽  
Self Management ◽  
Management Support ◽  
Care Model ◽  
Team Based Care

Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation.Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time.Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral.Conclusion. Our innovative program enables the existing health system to support ade novocare management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

Effects of a Primary Care–Based Chronic Care Model on Diabetes Self-Management, Diabetes Distress, and Health Care Experience

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 659-P
Author(s):  
ADDIE L. FORTMANN ◽  
JESSICA L. PRECIADO ◽  
CHRIS WALKER ◽  
ROBIN MORRISEY ◽  
KELLY BARGER ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Self Management ◽  
Diabetes Distress ◽  
Care Model ◽  
Care Experience ◽  
Health Care Experience

scholarly journals The Chronic Care Model and Chronic Condition Self-Management: An Introduction for Audiologists

2019 ◽  
Vol 40 (01) ◽  
pp. 007-025 ◽  
Author(s):  
Louise Hickson ◽  
Gitte Keidser ◽  
Carly Meyer ◽  
Elizabeth Convery
Keyword(s):  
Health Care ◽  
Chronic Care Model ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Chronic Care ◽  
Clinical Care ◽  
Self Management ◽  
Management Support ◽  
Care Model ◽  
Hearing Health

AbstractHearing health care is biomedically focused, device-centered, and clinician-led. There is emerging evidence that these characteristics—all of which are hallmarks of a health care system designed to address acute, rather than chronic, conditions—may contribute to low rates of help-seeking and hearing rehabilitation uptake among adults with hearing loss. In this review, we introduce audiologists to the Chronic Care Model, an organizational framework that describes best-practice clinical care for chronic conditions, and suggest that it may be a viable model for hearing health care to adopt. We further introduce the concept of chronic condition self-management, a key component of chronic care that refers to the knowledge and skills patients use to manage the effects of a chronic condition on all aspects of daily life. Drawing on the chronic condition evidence base, we demonstrate a link between the provision of effective self-management support and improved clinical outcomes and discuss validated methods with which clinicians can support the acquisition and application of self-management skills in their patients. We examine the extent to which elements of chronic condition self-management have been integrated into clinical practice in audiology and suggest directions for further research in this area.

scholarly journals Barriers and Facilitators towards an Integrated Chronic Care Model as experienced by primary care health providers

2016 ◽  
Vol 16 (6) ◽  
pp. 78 ◽  
Author(s):  
Geert Goderis ◽  
Gunther D'hanis ◽  
Gert Merckx ◽  
Wim Verhoevven ◽  
Pierre Sijbers ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Barriers And Facilitators ◽  
Health Providers ◽  
Care Model ◽  
Primary Care Health ◽  
Care Health

scholarly journals The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Katrien Danhieux ◽  
Veerle Buffel ◽  
Anthony Pairon ◽  
Asma Benkheil ◽  
Roy Remmen ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Qualitative Study ◽  
Chronic Care ◽  
Self Management ◽  
Management Support ◽  
High Risk Patients ◽  
Risk Patients ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

Recreation and collaboration within the Expanded Chronic Care Model: working towards social transformation

2020 ◽  
Vol 35 (6) ◽  
pp. 1531-1542
Author(s):  
Susan L Hutchinson ◽  
Heidi Lauckner
Keyword(s):  
Social Change ◽  
Chronic Care Model ◽  
Social Transformation ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Chronic Care ◽  
Self Management ◽  
Care Model ◽  
Community Based ◽  
Community Recreation

Abstract Assisting people to live well with a chronic physical or mental health condition requires the creation of intersectoral community-based supports for chronic condition self-management. One important but underutilized resource for supporting chronic condition self-management in the community is recreation, which refers to relatively self-determined and enjoyable physical, social or expressive everyday activities. The Expanded Chronic Care Model (ECCM) provides a framework for identifying systems-level strategies to support self-management through increased access to community recreation opportunities. In this article, an occupation-based social transformation approach, which involves examining assumptions, considering contexts of daily activities and partnering to create meaningful social change, is used to examine the ECCM. Recommendations related to strengthening social change with a specific focus on collaborations and networks through recreation are provided. Through such collaborations, self-management of chronic conditions in community recreation contexts is advanced. Health providers and community-based recreation services providers are invited to be part of these intersectoral changes that will promote health amongst those living with chronic conditions.

scholarly journals Features of the Chronic Care Model (CCM) Associated with Behavioral Counseling and Diabetes Care in Community Primary Care

2010 ◽  
Vol 23 (3) ◽  
pp. 295-305 ◽  
Author(s):  
P. A. O. Strickland ◽  
S. V. Hudson ◽  
A. Piasecki ◽  
K. Hahn ◽  
D. Cohen ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetes Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Care Model ◽  
Behavioral Counseling
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