Abstract
Introduction
The average life expectancy is increasing, as well as the number of patients suffering from chronic diseases. Chronic diseases have become the most important reason for morbidity and mortality, as they make up for 63% of all deaths in the world. The Chronic Care Model (CCM) is often used to achieve a good organization of, and interprofessional collaboration between the different actors in the primary care. Successful implementation of such a model is dependent on different factors.
The purpose of this study is to give an overview of the barriers and facilitators for a successful implementation of a care program based on the CCM in primary care.
Methods
In this systematic review, the databases Pubmed and Cinahl were used to obtain relevant literature. Both qualitative and quantitative studies were included. In the first phase screening was based on the title and abstract. During the second phase, the full text from included articles from phase one were assessed based on the in- and exclusion criteria. Data was then extracted from the remaining articles. Two types of data were acquired in this process. First of all, general data was obtained, specifically: study design, method, participants, setting, objective, components of the CCM and intervention. Afterwards, the barriers and facilitators were organized within the structure provided by the TICD-checklist.
Results
Of the 2075 screened results, 19 articles were included in the study. For every domain of the TICD-checklist, barriers and facilitators were found. The most prominent themes were professional interactions, and incentives and resources.
Discussions
There are a lot of barriers to the implementation of a care program based on the CCM. This systematic review showed that organizational, (intra)personal and policy factors are important for a successful implementation.
Lessons learned
This study offers an important overview of the barriers and facilitators for the implementation of a care program based on the CCM. Through these scientific insights, professionals can anticipate potential barriers and make use of identified facilitators to successfully implement a care program in practice.
Limitations and suggestion for further research
The focus was on care programs and chronic care. This focus was needed but in further research including individual diseases like diabetes, schizofrenia, … in the search terms would be a good idea since not all of these publications are found under the chronic diseases label.