Development of a Person-Centred Integrated Care Approach for Chronic Disease Management in Dutch Primary Care: A Mixed-Method Study

• Published in: International journal of environmental research and public health Vol. 20; no. 5; p. 3824
• Main Authors: Raaijmakers, Lena H A, Schermer, Tjard R, Wijnen, Mandy, van Bommel, Hester E, Michielsen, Leslie, Boone, Floris, Vercoulen, Jan H, Bischoff, Erik W M A
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 21.02.2023; MDPI
• Subjects: Analysis; Cardiovascular diseases; Care and treatment; Chronic conditions; Chronic Disease; Chronic diseases; Chronic illnesses; Chronic obstructive pulmonary disease; Comorbidity; Cost analysis; Delivery of Health Care, Integrated; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Disease Management; Health care; Health care industry; Humans; Integrated delivery systems; Lung diseases; Medical personnel; Methods; Mixed methods research; Obstructive lung disease; Patient-Centered Care - methods; Patients; Primary care; Professional relationships; Professionals; Pulmonary Disease, Chronic Obstructive; Qualitative research; Quality of life; Questionnaires; Netherlands; general practice; multimorbidity; primary care; chronic care management; person-centred care; chronic conditions; person-centred integrated care
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph20053824

To reduce the burden of chronic diseases on society and individuals, European countries implemented chronic Disease Management Programs (DMPs) that focus on the management of a single chronic disease. However, due to the fact that the scientific evidence that DMPs reduce the burden of chronic diseases is not convincing, patients with multimorbidity may receive overlapping or conflicting treatment advice, and a single disease approach may be conflicting with the core competencies of primary care. In addition, in the Netherlands, care is shifting from DMPs to person-centred integrated care (PC-IC) approaches. This paper describes a mixed-method development of a PC-IC approach for the management of patients with one or more chronic diseases in Dutch primary care, executed from March 2019 to July 2020. In Phase 1, we conducted a scoping review and document analysis to identify key elements to construct a conceptual model for delivering PC-IC care. In Phase 2, national experts on Diabetes Mellitus type 2, cardiovascular diseases, and chronic obstructive pulmonary disease and local healthcare providers (HCP) commented on the conceptual model using online qualitative surveys. In Phase 3, patients with chronic conditions commented on the conceptual model in individual interviews, and in Phase 4 the conceptual model was presented to the local primary care cooperatives and finalized after processing their comments. Based on the scientific literature, current practice guidelines, and input from a variety of stakeholders, we developed a holistic, person-centred, integrated approach for the management of patients with (multiple) chronic diseases in primary care. Future evaluation of the PC-IC approach will show if this approach leads to more favourable outcomes and should replace the current single-disease approach in the management of chronic conditions and multimorbidity in Dutch primary care.