The patients' perception of chronic care management in primary care
In New Zealand, primary care is responsible for the ongoing management of patients with chronic illness. These patients often have high health needs that require intensive clinical management. The New Zealand health system has provided the necessary leadership and financial incentives for primary care to implement a chronic illness programme (Care Plus) to meet the needs of this growing population. The objective of this study was to assess the extent to which patients enrolled in the Care Plus (CP) programme have received care that is congruent with the concepts of effective chronic care management (CCM). The study took place in a New Zealand primary care facility. A sample of 157 patients with chronic conditions and high users of health services completed a self-administered survey. The study was based on Wagner’s model for chronic illness care using a modified version of the Patient Assessment of Chronic Illness Care (PACIC) survey. This enabled two groups of chronically ill patients (intervention versus usual care) to rate the care they have received from their primary care provider to help them stay well. Between group survey scores were evaluated to determine changes in perception of the chronic illness care received as a result of the programme. Relationships between survey scores and patient characteristics were also evaluated. The findings of the study indicate that the patients, particularly Maori, enrolled in the CP programme believe that they have received services that are more congruent with the chronic care model. The concepts of CCM activity reported less often by both groups were follow-up and coordination. This provides direction for this primary care organisation to review their services and activities, making quality improvements that have the potential to improve outcomes for patients with chronic illness. The study also raises questions about the relationship between ethnicity and CCM.