1. o Type 2 diabetes has traditionally been managed as a single chronic disease state but it can commonly exist with co-morbidities such as depression. o Treatment is multifaceted, requiring both primary and secondary care, however, health service delivery is often fragmented. o Integrated chronic disease management is a growing model of interest underpinned by the Chronic Care Model (CCM) [2]. o The CCM identifies six key elements for effective care, and has shown promise in improving the management of diabetes. Introduction Methods Conclusions Results Integrated Chronic Disease Management in Primary/Secondary Care: A Systematic Review Martin Connor 1, David Lim 2, Lauren Ward 1, Julie Hepworth 2 1 Centre for Health Innovation, Griffith University 2 School of Public Health and Social Work, Queensland University of Technology o A systematic review of peer reviewed literature from PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs was conducted. o Studies were included that met the following criteria: Published in English, date range between 2004-2014, primary/secondary implementation, and interventions managing chronic disease. “The current challenge is to be specific about what integrated services look like – what are the key functions which need to be developed?” [ 3] o Fifty-one studies met the inclusion criteria: US (38), Australia (5), UK (2), Canada (2), Netherlands (1), Norway (1), Ireland (1), multi-country (1). o Interventions adopted at least one (x 4) element of the CCM, with the majority implementing delivery system redesign activities within primary care practice. o Interventions significantly reduced ED and hospital admissions, improved patient health outcomes such as HbA1c, and reduced costs. OutcomeMD (SE) Overall effect: d (P) Heterogeneity: I 2, P Hospital admission -1 per 1,000 patients (0.001) -0.59 (<0.001)4.44, <0.01 ED visit -13 per 1,000 patients (0.002) -0.77 (<0.001)2.38, 0.02 Primary health care utilization -18 per 1,000 patients (0.000) -0.26 (<0.001)1.24, 0.385 HbA1c changes (%) -2% over 24 months (0.000) -0.51 (<0.001)1.13, 0.420 Direct medical costs (2013, US$) -US$402.95 per patient (US$48.41) -0.64 (<0.001)0.047, <0.01 Chronic disease accounted for 90% of all deaths in 2011 [1] Aim o Integrated chronic disease management interventions have numerous definitions and components. o Integrated care interventions involving elements of the CCM positively impacted service utilisation, patients outcomes and costs. o Preliminary analysis indicates that the adoption of all CCM elements may not be necessary to improve clinical outcomes and cost effectiveness. References 1 Australian Institute of Health and Welfare. Australia’s health 2014: Australia’s health series no. 14. Canberra: AIHW; 2014 [cited 2014 August 10]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547726 2 Bodenheimer T., Wagner EH., & Grumbach K. Improving Primary Care for Patients with Chronic Illness. JAMA. 2002; 288(14):1775-9 3 World Health Organisation. Integrated Health Services- What and Why? Making Health Systems Work. Technical Brief No. 1. Geneva: WHO; 2008. [cited 2014 August 10]. Available from : http://www.who.int/healthsystems/service_delivery_techbrief1.pdf To investigate the effectiveness of integrated chronic disease management interventions across primary/secondary care. Clinical Information Systems CHRONIC CARE MODEL ELEMENTS Delivery System Design Self-management support Decision Support Community Linkages Health Care Organisation Total citations identified by search: N= 953 Included Papers: N= 775 Duplicates: N= 175 Not English: N= 3 Passed full text screening and included in review: N= 29 Passed title and abstract screen. Full manuscripts obtained and reviewed for inclusion: N= 164 Included papers: N= 51 Excluded by abstract and title: N= 611 Excluded (N= 135) Reasons for exclusion: 1.Emailed author N= 6 2.Not specifically evaluating integrated care N= 44 3.Not primary/secondary integrated intervention N= 11 4.Opinions about integrated care N= 47 5.Paediatrics N= 12 6.Not primary study N= 14 7.Not Chronic Disease N= 1 Snowball papers retrieved N = 30 Excluded N= 8 (Subject to exclusion criteria above) Figure 1. Stages of the literature search process Table 1. Mean Differences of Key Outcome Measures