Congruency of diabetes care with the Chronic Care Model in different Swiss health care organisations from the patients' perspective: A cross sectional study

Abstract

QUESTIONS UNDER STUDY: Patients with chronic illnesses like diabetes mellitus benefit from care following the concept of the Chronic Care Model. To improve quality and to be responsive to patients' needs reliable data on patients' view of care in different healthcare settings are required. We evaluated the congruency of diabetes care with the Chronic Care Model between managed and non-managed care organisations from a patient's perspective. METHODS: We compared type 2 diabetes patients from non-managed care with a managed care organisation in Switzerland. We evaluated differences between these settings with the Patient Assessment of Chronic Illness Care 5A questionnaire (PACIC 5A; scale from 1-5) that combines the PACIC and the 5A-approach of physicians' counselling. RESULTS: 374 patients completed the PACIC 5A (326 from non-managed care settings, 48 from managed care). The adjusted average PACIC summary score was 3.18 in the non-managed care compared to 3.49 in the managed care sample (p = 0.046). Managed care patients scored significantly higher in the subscales goal setting (2.86 vs 3.29; p = 0.015), advice (3.23 vs 3.64; p = 0.014), assist (2.98 vs 3.44; p = 0.016) and arrange (2.50 vs 2.88; p = 0.049). CONCLUSIONS: Our data from different health care settings suggest that managed care is recognised by type 2 diabetes patients as care that is more congruent with the Chronic Care Model and offers more intense behavioural counselling and self-management support compared with usual primary care in Switzerland. Future research should evaluate larger, more comparable patient groups.