Figure 1
Stepwise development of the model.
Table 1
Implications and recommendations for the final model.
| # | Study design; Objective | Implications and recommendations for the final model |
|---|---|---|
| 1 | Literature review to identify chronic care programs and structure their components | Rare/missing data on the effectiveness and quality of chronic care programs and their components |
| 2 | Systematic Review on effectiveness of CCM [18]; to systematically identify studies of diabetes care assessing the effect of interventions addressing all six components of the CCM | Limited evidence on the effectiveness of implementing all CCM-components simultaneously in older patients in Europeand lack of data to understand the intensity of the intervention. Patients with screen-detected T2DM and patients with newly diagnosed T2DM showed improved effects on HbA1c → focus on prevention and health promotion |
| 3 | Standardised survey (n = 92) of experts in chronic care [19]; to analyse existing chronic care programs focusing on effective, problematic and missing components | “Financial support” (no tangible incentives, scarcity of funding, and no refund) regarded as missing in current care programs. Case management and quality management should be an integral part of chronic care management. The incorporation of social services and informal social support, especially for people with complex health and social care needs, is strongly recommended. |
| 4 | Expert workshop (n = 22) of HCP and experts of a European funded research project MANAGE CARE [19]; to define a limited number of unmet needs and priorities of elderly patients with T2DM and comorbidities | Evidence-based chronic care must be available and affordable to patients. Cooperative systems are conducive to better chronic care management, including care navigation, care planning and risk stratification. Measures to evaluate the effectiveness, quality and feasibility of careusing predefined Shared Outcome Frameworks (triple aim) without being limited to medical outcomes need to be implemented. |
| 5 | Multilingual online survey of patients and health care providers (n = 650) [19]; to validate and rank the identified patient needs | Chronic care must address individual patient needs and preferences as much as medical treatment objectives. Education of patients as well as prevention and health promotion are integral to chronic care management. Pro-active communication with the patient should be supported. |
[i] The left column shows the five methodological steps and their relevant study objectives combining previously published and current results. The right column summarises recommendations of the single analyses guiding the development of the model.
Figure 2
Differences in ratings by user group for selected needs dimensions.
The four graphs illustrate the significant (** p < 0.01; *** p < 0.001) differences in rankings of patients and HCPs for the needs dimensions “Education of patients”, “Health promotion and all kinds of prevention”, “Communication with the team and with the patient” and “Availability of services related to information infrastructure”. All four indicate higher priorities for patients compared to HCPs.
Table 2
Description of participants during consensus meetings.
| Date, place | Overall number of participants | Number of participants per country |
|---|---|---|
| Berlin, February 2016 | 10 | Germany (n = 4); Greece (n = 2); EU (n = 2); Belgium (n = 1); Poland (n = 1) |
| Athens, April 2016 | 14 | Greece (n = 5); Germany (n = 3); EU (n = 1); Belgium (n = 1); Poland (n = 1); Portugal (n = 1); Lithuania (n = 1); Finland (n = 1) |
| Barcelona, May 2016 | 24 | Germany (n = 8); Greece (n = 4); Serbia (n = 3); Austria (n = 2); EU (n = 2); Portugal (n = 2); Belgium (n = 1); Lithuania (n = 1); Finland (n = 1) |
Figure 3
MANAGE CARE Model.
MANAGE CARE Model including seven core components for the innovative chronic disease management of patients with diabetes (risk).