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

Lena H A Raaijmakers; Tjard R Schermer; Mandy Wijnen; Hester E van Bommel; Leslie Michielsen; Floris Boone; Jan H Vercoulen; Erik W M A Bischoff

doi:10.3390/ijerph20053824

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

Int J Environ Res Public Health. 2023 Feb 21;20(5):3824. doi: 10.3390/ijerph20053824.

Authors

Lena H A Raaijmakers¹, Tjard R Schermer^{1

2}, Mandy Wijnen¹, Hester E van Bommel^{1

3}, Leslie Michielsen^{1

4}, Floris Boone¹, Jan H Vercoulen⁵, Erik W M A Bischoff¹

Affiliations

¹ Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
² Science Support Office, Gelre Hospitals, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands.
³ Pharos, Dutch Centre of Expertise on Health Disparities, P.O. Box 13318, 3507 LH Utrecht, The Netherlands.
⁴ Research Group Innovation of Care and Services, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
⁵ Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

Abstract

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.

Keywords: chronic care management; chronic conditions; general practice; multimorbidity; person-centred care; person-centred integrated care; primary care.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Chronic Disease
Delivery of Health Care, Integrated*
Disease Management
Humans
Patient-Centered Care / methods
Pulmonary Disease, Chronic Obstructive*

Grants and funding

This research was funded by ZonMw (Netherlands Organisation for Health Research and Development), grant number HGOG 8391 10024.