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Meriam Sadiq H. Alabdallah et al, 2020;4(2):504–508.

International Journal of Medicine in Developing Countries

Managing chronic disease in primary care: a review

Meriam Sadiq H. Alabdallah1*, Abdulmajeed Salman S. Almalki2, Ahmed Saeed Alsaedi3, Ahmed Mohammed H. Abdullah3, Faisal Hamdan A. Aljuhine4, Abdullah Khalid Attar3

Correspondence to: Meriam Sadiq H Alabdallah

*Prince Saud bin Jalawi Hospital, Alahsa, Saudi Arabia.

Email: meriam_sa [at] outlook.com

Full list of author information is available at the end of the article.

Received: 11 December 2019 | Accepted: 08 January 2020


ABSTRACT

It has been known that chronic diseases (CDs) take a very long time and its progression is always low for any health system. Financial and organizational problems are considered to be a tremendous burden on the health system. Patients who have numerous CDs, such as depression, have their functional capacity decreased, and they need greater health care. We used an online searching process to obtain scientific articles related to our subject. We obtained 26 articles related to the current subject; of them, 19 were excluded as they were duplicate articles, published before 2000 or not focusing on the current subject. Hence, only seven articles were included, which were published between 2005 and 2019. Articles were selected according to the inclusion criteria that we selected, and then, the discussion of the subject was performed under main titles. The study concludes that the prevention of CD is very important for the development of the economy. CD management is a challenge for healthcare providers. It is very important to enhance management’s quality of CDs for patients by providing better treatment in primary care settings, in addition to self-supportive management for the patient.


Keywords:

Chronic diseases, prevalence, management, primary care.


Introduction

Chronic disease (CD) is characterized by long, time-consuming, and slow progressing diseases that do not transfer from one patient to another [1-3]. Commonly in the developed countries, CDs increase with increasing age [4]. The majority of morbidity reported was 70% at 85 years of age, whereas 50% for 65–74 years of age and a little percentage (40%) was for those with age over 44 years [5]. Risks of these CDs and its complications have been increased by poverty and social exclusion that led to death [6]. Patients who had CDs need advanced care, such as episodic care for the good management of CDs according to primary care’s distinctive features [7,8]. Primary care has been shown to be more proactive, therefore assisting in the enhancement of health care and policy of chronic healthcare systems [9]. The availability of a coefficient primary healthcare system was found to promote and introduce a better health system with a bit cost as reported in developing countries [10]. On the other hand, other communities performed an innovative solution with a high cost for diminishing the harmful effect of CD morbidity and mortality but could not affect the quality of health care of CD [6],whereas other countries of low and middle income always suffer from non suitable access and insufficient matters, such as drugs.

Primary care means applying a healthcare system for numerous patients who had CDs [11]. Primary care programs, such as chronic disease prevention and management (CDPM), were found to benefit healthcare patients who had CDs [12]. CDPM programs are usually designed by special teams for enhancing the quality of life, services of health care, individual management, and usage of medicine for patients who were infected with CDs. Throughout previous decades, a majority of models for the management of CDs with high quality were found to be developed [13]; from these models, Chronic Care Model (CCM) was the obvious one in different developing countries in which the practicing of CD health care was changed [14]. One benefit of these models was guidance for achieving a good management system with high quality for chronic conditions. These models could be applied in huge and enormous countries other than developed ones [15]. To improve the primary healthcare management quality, other approaches were used, such as patient-centered medical at home and ten building blocks of high performance [16]. In the primary care, CD prevention and treatment required an effective management in a definite type and performance [8]. Therefore, this study aimed to clarify the models that support innovative management and treatment of CDs in the primary care health system.


Materials and Methods

We used an online searching process to obtain the scientific articles related to the current subject. The searching process involved searching through scientific websites, such as Google Scholar and PubMed, using several keywords, such as CDs, management, prevention, and primary care. We obtained 26 articles related to the current subject; of them, 19 were excluded as they were duplicate articles, published before 2000 or not focusing on the current subject, so only seven articles were included and they were published between 2005 and 2019.


Discussion

Primary care system and management of CDs

The primary care is considered as one of the important healthcare systems all over the world according to the World Health Organization’s announcement, in 1978. The primary care could be identified by introducing services by clinicians and medications who had the ability to address/treat numerous patients who need health care, also proceeding collaboration with patients and their families [17]. Practicing of the primary care had distinctive features such as universal and coordinated features [18]; furthermore, it could be more suitable for any chronic case of the patient as it supports effective medical care. Lacking essential and operative primary care might be led to a high risk of drug reaction, hospital action, and other complications in CD patients [19]. Therefore, remediation of these high-risk CDs became urgent using specific approaches with an effective strategy among the population who suffer from high-risk chronic conditions [6]. The intervention of the primary care and policies of public health that treated, prevented, and controlled the CDs were found to be more operative and effective than the other secondary and tertiary ones as reported by public policy and the challenge of chronic diseases [20]. Provident of that specialist primary care is more effective than the generalist one though the practice of both of them was lacked [21]. A combination of specialists’ primary and secondary care might offer an optimized type of knowledge and skills in the management of CD [22].

Physicians do not concern with the design of body health services according to the care system, due to the quality of the primary care of CDs [8]. All over the world, episodic and incidental illnesses have been found to raise the system of primary health care. Low- and middle-income countries had a healthcare system that did not involve nor had an obvious effect on managing and treating CDs [13]. Chronic conditions required health care that entirely differentiated from that used in case of acute problems as it depends on collaboration. Hence, the model of primary health care was developed to raise the care for acute problems. For more effectiveness, such types of levels were applied, as the macrolevel included an enhancement in the patients’ care [23]. Equitable distribution should be applied definitely for the financial problems of CD and cost-effective interventions. However, adding capitalization did not enhance the quality of primary care management for CDs through the system of primary health care.

Primary care of doctors and allied health care should be trained in high quality as reported by Anis [24]. This effective training for medications would support the management of CDs. Therefore, increasing the number of trained physicians and other medications could improve their personal skills, attitude, and knowledge and consequently raise the management of CDs. In addition to such types of drugs and specific equipment in the laboratory, an important diagnosing and managing of CDs are also required in primary care. Effective and qualified exploitation should be made for collecting information about the system of health care and putting a plan and strategy for the health care that might take a long time. This would be accomplished through registration of the decision of clinical guidelines every day [25]. Last but not least, performing a partnership with patients and their families is very urgent for improving the health care. The ability of patients and their family members to complete their responsibility in the management of their chronic conditions was relied on keeping this collaboration with medications [26]. As reported by a study [27], the management of patient by themselves through definite program has been found to decrease the chronic symptoms, and boosting their confidence to deal with CDs, for example, patients who had suitable information and skills through an effective education, had the ability to treat, control, and manage their CDs. Hence, we could say that effective training and education are very essential for patients, doctors, and under- and postgraduate level, and other medications were required for accomplishing a good management for CD.

CCM in primary care organizations

A qualitative study of a randomized controlled trial was conducted by Fortin et al. [28] in the Saguenay region, Quebec, Canada, in eight primary healthcare practices. The self-management program of patient and collaboration in a team was supported through an effective method. An interview was conducted by Fortin et al. [28] among patients and their family members with qualified medications; hence, this type of intervention had a positive effect on patients and their family members, which might be related to the improvement of their awareness and knowledge, additionally increases the health behaviors and status, and also enhances the quality of life. On the other hand, it had a negative impact on patients, such as help in losing intervention beneficial effect. In this study, quantitative results were depended on the quantitative one [29]. Furthermore, the qualitative and quantitative studies reported an obvious knowledge among patients and enhanced the individual management of patients, health behavioral adoption, as well as raising the consumption rate of fruits and vegetables; not only this but also practicing some physical activity improve the quality of life among the patients. There was a harmony between the effects of qualitative and quantitative results. Furthermore, the qualitative findings supplement the richness that related to the quantitative results. The quantitative findings were showed by the patients of CDs and their family members as a term of life experience and perspective. Other positive effects of the qualitative results, such as enhancing motivation, empowerment, and health status enhancement, increased the results concerned with the research of the program.

On the other hand, Fortin et al. [28] results are in harmony with previous reviews on CD populations, who assumed that the application and usage of CCM in the primary care systems might enhance the patient’s outcome [30]. The findings of Fortin et al. [28] confirmed the effective intervention strategy that responded to the collaboration of patients and other members of the family with specific teams of medications. In addition, the results of Fortin et al. [28] were very important due to its program that manages numerous severe chronic conditions; otherwise, other programs were concerned only with primary care [31]. The motivation of patients during the entry of the program would determine the positive effect and the evaluation of the qualitative results [32]. Other positive impacts have been shown in patients who adopted healthy behaviors, whereas patients who had CDs were found to proceed with definite changes in their health behaviors before the onset of the program. This program helped patients through such motivation and control of health behaviors. All over the world, patients with high morbidity found problems in the system of health care. Fortin [28] showed that higher percentages of patients had different chronic conditions. Both the quantitative and qualitative results confirmed the importance of the integration of patients in a team, which would increase the benefit of primary care programs, such as the CDPM program, even for a short duration.

In the qualitative method that was previously reported by Braillard et al. [33], an interview was performed with clinicians who were working either individually or in a hospital in Geneva, Switzerland. They described that medical personnel, as doctors, showed some management difficulties for a patient with CDs. Management of CDs used the qualified rules that might be used as a key element for investigating the interactions between doctor and patient; this collaboration is necessary for achieving an effective management of CDs in primary care. Time limitations and more social factors were considered to be a barrier to achieve CD management.

Numerous literature and authors showed that approximately 20%–40% of doctors of primary care were completely fatigued because of some factors that are linked to the nature of their work. Furthermore, doctors’ incomes are linked to the number of patients that have been seen, in addition to the number of work hours and stress attitudes in private practice [34,35]. A study reported by Kenning [36] showed that the complication in CD management was the emotional attitude as they face a problem to be willingly engaged in their own care.

Time limitation was found to prevent the improvement of the collaboration as shown by the health system; this relationship could be described by the improvement of CD management [36]. The way, in which the system of health care supports the care for chronic patients and affects medical professionals, such as doctors should be altered. To eliminate the overload of work on doctors and other members of the medical field, different resources are required to support the integration between patients and doctors. Furthermore, a trained manager in the team would be effective [37].


Conclusion

To maintain and increase the development of the economy, CDs should be controlled, prevented, and managed. According to studies that were conducted around the whole world and based on the ignorance of the government, it was found that approximately 388 million of the population will die in the next 10 years due to the severity of CDs [6]. It was shown that the burden increment of CD was expected. CD management and treatment became major challenges for the healthcare system depending on different patients’ characters. Hence, for achieving effective management for these CDs, obvious changes should be applied, such as effective education for patients, providing healthcare systems, and adopted guidelines that are essential for a good relationship that is urgent for the process of management. The importance of medical education was to prepare doctors for the emotional attitude and availability of innovative finance mechanisms.

Practicing primary care is very important for the management of CD patients. However, all over the world, it was found that systems of primary care were raised as a result of acute problems that might lead to an increase in the prevalence of CDs. Models for primary care controlled the health care and enhance the health care of populations. Finally, the application of the primary care model for a long time was found to increase primary health care and solve health problems, such as the rising epidemic of CDs.


List of Abbreviations

CCM Chronic care model
CDPM Chronic disease prevention and management
CD Chronic disease

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Meriam Sadiq H. Alabdallah1, Abdulmajeed Salman S. Almalki2, Ahmed Saeed Alsaedi3, Ahmed Mohammed H. Abdullah3, Faisal Hamdan A. Aljuhine4, Abdullah Khalid Attar3

  1. Prince Saud bin Jalawi Hospital, Alahsa, Saudi Arabia
  2. Medical Intern, Umm Al Qura University, Mecca, Saudi Arabia
  3. Medical Intern, Taif University, Taif, Saudi Arabia
  4. General Practitioner, Alsulaimaniah Primary Health Care, Jeddah, Saudi Arabia

References

  1. Palladino R, Tayu Lee J, Ashworth M, Triassi M, Millett C. Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries. Age Ageing. 2016;45(3):431–5. https://doi.org/10.1093/ageing/afw044
  2. Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, et al. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16:173. https://doi.org/10.1186/s12913-016-1421-7
  3. World Health Organization. Global status report on noncommunicable diseases; 2014 [cited 2019 Nov]. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/
  4. Dennis S. Secondary prevention of chronic health conditions in patients with multimorbidity: what can physiotherapists do? J Comorb. 2016;6:50–2. https://doi.org/10.15256/joc.2016.6.82
  5. Australian Institute of Health and Welfare. Chronic diseases; 2015 [cited 2016 Apr 5]. Available from: http://www.aihw.gov.au/chronic-diseases/
  6. WHO. Preventing chronic diseases: a vital investment [online].Geneva: World Health Organisation; 2005 [cited 2008 Feb 13]. Available from: http://www.who.int/chp/chronic_disease_report/full_report.pdf
  7. World Health Organization. Innovative care for chronic conditions: building blocks for action; 2001 [cited 2017 Sep 5]. Available from: http://www.who.int/chp/knowledge/publications/icccreport/en/
  8. Rothman AA, Wagner EH. Chronic iIllness management: what is the role of primary care?. Ann Intern Med. 2003;138:256–61. https://doi.org/10.7326/0003-4819-138-3-200302040-00034
  9. Ham C. The ten characteristics of the high-performing chronic care system. Health Econ Policy Law. 2010;5(Pt 1):71–90. https://doi.org/10.1017/S1744133109990120
  10. Phillips R, Starfield B. Why does a US primary care workforce crisis matter?. Am Fam Phys. 2003 68(8):1494–500.
  11. Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med. 2012;10(2):142–51. https://doi.org/10.1370/afm.1337
  12. Wenger NS, Roth CP, Shekelle PG, Young RT, Solomon DH, Kamberg CJ, et al. A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia. J Am Geriatr Soc. 2009;57(3):547–55. https://doi.org/10.1111/j.1532-5415.2008.02128.x
  13. WHO. Innovative care for chronic conditions: building blocks for action. Geneva, Switzerland: World Health Organization; 2002 [cited 2008 Feb 26]. Available from: http://www.who.int/diabetesactiononline/about/icccglobalreport.pdf
  14. Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH. Improving the quality of health care for chronic conditions. Qual Saf Health Care. 2004;13(4):299–305. https://doi.org/10.1136/qshc.2004.010744
  15. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9. https://doi.org/10.1001/jama.288.14.1775
  16. Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med. 2014;12(2):166–71. https://doi.org/10.1370/afm.1616
  17. Safran DG. Defining the future of primary care: what can we learn from patients? Ann Intern Med. 2003;138(3):248–55. https://doi.org/10.7326/0003-4819-138-3-200302040-00033
  18. Starfield B. Primary care: balancing health needs, services and technology. New York: Oxford Univ Press; 1998. 2001;1:448.
  19. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–76. https://doi.org/10.1001/archinte.162.20.2269
  20. Adeyi O, Smith O, Robles S. Public Policy and the Challenge of Chronic Noncommunicable Diseases [online]. Washington, DC: World Bank; 2007 [cited 2019 Sep]. Available from URL: http://siteresources.worldbank.org/INTPH/Resources. https://doi.org/10.1596/978-0-8213-7044-5
  21. McAlister FA, Majumdar SR, Eurich DT, Johnson JA. The effect of specialist care within the first year on subsequent outcomes in 24,232 adults with new-onset diabetes mellitus: population-based cohort study. Qual Saf Health Care. 2007;16(1):6–11. https://doi.org/10.1136/qshc.2006.018648
  22. Lafata JE, Martin S, Morlock R, Divine G, Xi H. Provider type and the receipt of general and diabetes-related preventive health services among patients with diabetes. Med Care. 2001;39(5):491–9. https://doi.org/10.1097/00005650-200105000-00009
  23. Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH. Improving the quality of health care for chronic conditions. Qual Saf Health Care. 2004;13(4):299–305. https://doi.org/10.1136/qshc.2004.010744
  24. Ramli A. Chronic disease management in primary care - a review of evidence. Med Health Rev. 2008;1:63–80.
  25. Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof. 2004;24 Suppl 1:S31–7. https://doi.org/10.1002/chp.1340240506
  26. Department of Health (UK). The expert patient: a new approach to chronic disease management for the 21st century [online]. Crown Copyright; 2001 [cited 2008 Feb 26]. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
  27. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–75. https://doi.org/10.1001/jama.288.19.2469
  28. Fortin M, Chouinard MC, Diallo BB, Bouhali T. Integration of chronic disease prevention and management services into primary care (PR1MaC): findings from an embedded qualitative study. BMC Fam Pract. 2019;20(1):7. https://doi.org/10.1186/s12875-018-0898-z
  29. Fortin M, Chouinard M-C, Dubois M-F, Bélanger M, Almirall J, Bouhali T, et al. Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC). CMAJ Open. 2016;4:E588–98. https://doi.org/10.9778/cmajo.20160031
  30. Fortin M, Chouinard MC, Bouhali T, Dubois MF, Gagnon C, Bélanger M. Evaluating the integration of chronic disease prevention and management services into primary health care. BMC Health Serv Res. 2013;13(1):132. https://doi.org/10.1186/1472-6963-13-132
  31. Tan WS, Ding YY, Xia WC, Heng BH. Effects of a population-based diabetes management program in Singapore. Am J Manag Care. 2014;20(9):e388–98.
  32. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992;47(9):1102–14. https://doi.org/10.1037/0003-066X.47.9.1102
  33. Braillard O, Slama-Chaudhry A, Joly C, Perone N, Beran D. The impact of chronic disease management on primary care doctors in Switzerland: a qualitative study. BMC Fam Pract. 2018;19(1):159. https://doi.org/10.1186/s12875-018-0833-3
  34. Torppa MA, Kuikka L, Nevalainen M, Pitkälä KH. Emotionally exhausting factors in general practitioners’ work. Scand J Prim Health Care. 2015;33(3):178–83. https://doi.org/10.3109/02813432.2015.1067514
  35. Sinnott C, Mc Hugh S, Browne J, Bradley C. GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open. 2013;3(9):e003610. https://doi.org/10.1136/bmjopen-2013-003610
  36. Kenning C, Fisher L, Bee P, Bower P, Coventry P. Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: a qualitative study. SAGE Open Med. 2013;1:2050312113510001. https://doi.org/10.1177/2050312113510001
  37. Hudon C, Chouinard MC, Diadiou F, Lambert M, Bouliane D. Case management in primary care for frequent users of health care services with chronic diseases: a qualitative study of patient and family experience. Ann Fam Med. 2015;13(6):523–8. https://doi.org/10.1370/afm.1867


How to Cite this Article
Pubmed Style

Alabdallah MSH, Almalki ASS, Alsaedi AS, Abdullah AMH, Aljuhine FHA, Attar AK. Managing chronic disease in primary care: a review. IJMDC. 2020; 4(2): 504-508. doi:10.24911/IJMDC.51-1576048326


Web Style

Alabdallah MSH, Almalki ASS, Alsaedi AS, Abdullah AMH, Aljuhine FHA, Attar AK. Managing chronic disease in primary care: a review. https://www.ijmdc.com/?mno=77559 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1576048326


AMA (American Medical Association) Style

Alabdallah MSH, Almalki ASS, Alsaedi AS, Abdullah AMH, Aljuhine FHA, Attar AK. Managing chronic disease in primary care: a review. IJMDC. 2020; 4(2): 504-508. doi:10.24911/IJMDC.51-1576048326



Vancouver/ICMJE Style

Alabdallah MSH, Almalki ASS, Alsaedi AS, Abdullah AMH, Aljuhine FHA, Attar AK. Managing chronic disease in primary care: a review. IJMDC. (2020), [cited October 15, 2021]; 4(2): 504-508. doi:10.24911/IJMDC.51-1576048326



Harvard Style

Alabdallah, M. S. H., Almalki, . A. S. S., Alsaedi, . A. S., Abdullah, . A. M. H., Aljuhine, . F. H. A. & Attar, . A. K. (2020) Managing chronic disease in primary care: a review. IJMDC, 4 (2), 504-508. doi:10.24911/IJMDC.51-1576048326



Turabian Style

Alabdallah, Meriam Sadiq H., Abdulmajeed Salman S. Almalki, Ahmed Saeed Alsaedi, Ahmed Mohammed H. Abdullah, Faisal Hamdan A. Aljuhine, and Abdullah Khalid Attar. 2020. Managing chronic disease in primary care: a review. International Journal of Medicine in Developing Countries, 4 (2), 504-508. doi:10.24911/IJMDC.51-1576048326



Chicago Style

Alabdallah, Meriam Sadiq H., Abdulmajeed Salman S. Almalki, Ahmed Saeed Alsaedi, Ahmed Mohammed H. Abdullah, Faisal Hamdan A. Aljuhine, and Abdullah Khalid Attar. "Managing chronic disease in primary care: a review." International Journal of Medicine in Developing Countries 4 (2020), 504-508. doi:10.24911/IJMDC.51-1576048326



MLA (The Modern Language Association) Style

Alabdallah, Meriam Sadiq H., Abdulmajeed Salman S. Almalki, Ahmed Saeed Alsaedi, Ahmed Mohammed H. Abdullah, Faisal Hamdan A. Aljuhine, and Abdullah Khalid Attar. "Managing chronic disease in primary care: a review." International Journal of Medicine in Developing Countries 4.2 (2020), 504-508. Print. doi:10.24911/IJMDC.51-1576048326



APA (American Psychological Association) Style

Alabdallah, M. S. H., Almalki, . A. S. S., Alsaedi, . A. S., Abdullah, . A. M. H., Aljuhine, . F. H. A. & Attar, . A. K. (2020) Managing chronic disease in primary care: a review. International Journal of Medicine in Developing Countries, 4 (2), 504-508. doi:10.24911/IJMDC.51-1576048326