Worldwide, chronic diseases constitute a major burden for communities in terms of morbidity, disability and mortality. Chronic disease management (CDM) strategies have been developed as a means of reorganizing healthcare systems and medical treatment for chronic diseases. They are centered on patient's needs, based on formal evidence of effectiveness, foster the coordination and the integration of health services provided by various professionals, promote the self-management by the patient and, more generally, aim at improving communication between patients and healthcare providers.
A wider implementation of CDM programs is appealing. However, while single components of CDM programs can improve quality of care of chronic diseases, it remains unclear how much each component is essential and which combination of elements brings the greatest benefit to patients. In addition, the implementation of CDM in real life remains challenging. The proposed research plan should enable the continuation of the development and evaluation of chronic disease management, both in Switzerland and elsewhere.
The two-year research proposal for the PROSPER prolongation (2012-2013) targets the following objectives:
1) To assess the quality of care of diabetic patients residing in the canton of Vaud, within the context of the development of the “Programme cantonal Diabète”;
2) To validate the French version of the PACIC questionnaire, used to assess how care for diabetic patients is congruent with the “Chronic Care Model” recommendations;
3) To assess the effectiveness of the “Programme cantonal Diabète”, as well as the impact of exposure to CDM components, using a prospective cohort study;
4) To continue to collaborate with regional as well as national and international partners within the field of chronic disease management.
It is of utmost importance to address CDM approaches to improve chronic illness care. This is why interest for CDM research activities is continuing to grow, both in Switzerland and elsewhere. However, in an innovative field of research characterized by differences in healthcare contexts, study designs and populations, intervention components, measures selected and duration of interventions and follow-up, just to mention a few, it remains challenging to implement and evaluate CDM. Therefore, room for further improvement, research and development in the field of CDM still exists.
It is important to emphasize the importance, in the current Swiss healthcare context, of continuing to support and help develop independent research in the field of CDM. Indeed, a thorough evaluation of the Swiss situation may be paramount and valuable not only for existing programs, but also for institutions such as academic medical centers, practicing physicians and other care providers, patients and policy makers. Recommendations and suggestions eventually provided by these projects could be extremely useful for the implementation of CDM programs in Switzerland. This is particularly true because Switzerland presents some characteristics that may hinder the development of such innovations. In that context, it is essential to create a role model. Gradual implementation and start with pilot studies in a few cantons, focusing on few diseases, as well as evaluations of current projects represent necessary steps.
The proposed prolongation projects have broad potential applications for improving care of people suffering from chronic diseases. Given the potential benefits on population outcomes, the rewards of such interventions maybe significant in terms of health and cost burden due to chronic conditions.