title: Evaluating the integration of chronic disease prevention and management services into primary health care.
abstract: BACKGROUND
  The increasing number of patients with chronic diseases represents a challenge for health care systems. The Chronic Care Model suggests a multi-component remodelling of chronic disease services to improve patient outcomes. To meet the complex and ongoing needs of patients, chronic disease prevention and management (CDPM) has been advocated as a key feature of primary care producing better outcomes, greater effectiveness and improved access to services compared to other sectors. The objective of this study is to evaluate the adaptation and implementation of an intervention involving the integration of chronic disease prevention and management (CDPM) services into primary health care.
  
  
  METHODS
  The implementation of the intervention will be evaluated using descriptive qualitative methods to collect data from various stakeholders (decision-makers, primary care professionals, CDPM professionals and patients) before, during and after the implementation. The evaluation of the effects will be based on a combination of experimental designs: a randomized trial using a delayed intervention arm (n = 326), a before-and-after design with repeated measures (n = 163), and a quasi-experimental design using a comparative cohort (n = 326). This evaluation will utilize self-report questionnaires measuring self-efficacy, empowerment, comorbidity, health behaviour, functional health status, quality of life, psychological well-being, patient characteristics and co-interventions. The study will take place in eight primary care practices of the Saguenay region of Quebec (Canada). To be included, patients will have to be referred by their primary care provider and present at least one of the following conditions (or their risk factors): diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, asthma. Patients presenting serious cognitive problems will be excluded.
  
  
  CONCLUSIONS
  In the short-term, improved patient self-efficacy and empowerment are expected. In the mid-term, we expect to observe an improvement in health behaviour, functional health status, quality of life and psychological well-being. At the organizational level, the project should lead to coordinated service delivery, improved patient follow-up mechanisms and enhanced interprofessional collaboration. Integration of CDPM services at the point of care in primary care practices is a promising innovation in care delivery that needs to be thoroughly evaluated.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01319656.
authors.affiliation: Département de médecine de famille, Université de Sherbrooke, Québec, Canada. Martin.Fortin@USherbrooke.ca
authors.forename: Martin
authors.initials: M
authors.lastname: Fortin
authors.forename: Maud-Christine
authors.initials: MC
authors.lastname: Chouinard
authors.forename: Tarek
authors.initials: T
authors.lastname: Bouhali
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Dubois
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gagnon
authors.forename: Martin
authors.initials: M
authors.lastname: Bélanger
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005194:Family Practice / Q000592:standards; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration; D018802:Patient-Centered Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000592:standards*; D011792:Quebec; D012307:Risk Factors; D012648:Self Care / Q000379:methods; D020377:Self Efficacy; D012923:Social Class; D011795:Surveys and Questionnaires
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