The DOI matches its Crossref record; 63 of the 64 references it cites were found in a registry or an index.
Facilitators and barriers of implementing the chronic care model in primary care: a systematic review
Open accessAbstract
BACKGROUND: The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. METHODS: This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. RESULTS: This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. CONCLUSIONS: These findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers' and organizational perspective.
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“Research papers more often tend to report clinical level variables (such as information given to patients to support self-management) than to assess organisational factors, such as professional culture, governance, financial management, communication patterns, implementation readiness, or presence of supportive leadership 35 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [35]
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“In other similar studies, positive effects have been shown for people with depression 34 35 , chronic obstructive pulmonary disease 35 , asthma 35 36 , diabetes 35 36 and heart failure 36 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [35]
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Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · cited 1×
“The PRISMA statement provides an evidence-based checklist intended to improve the standards of reporting in systematic reviews [31].”
MethodDamschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009) · Implementation Science · doi:10.1186/1748-5908-4-50 · Cited by 14,496 · cited 13×
“The CFIR was selected because it includes multiple constructs and theories from peer reviewed studies on evidence-based knowledge dissemination and translation, organizational change and implementation, and uptake of research.”
BackgroundMethodInfluentialLiberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00136 · Cited by 10,349
Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations
GREENHALGH, T., ROBERT, G., MACFARLANE, F., BATE, P., & KYRIAKIDOU, O. (2004) · The Milbank Quarterly · doi:10.1111/j.0887-378x.2004.00325.x · Cited by 7,448 · cited 1×
“It provides a conceptual framework which can be used to understand factors that influence successful implementation in health care, and is based on theories identified by Greenhalgh and colleagues’ widely cited systematic review [26,32].”
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Improving chronic illness care: translating evidence into action
Wagner, E. H., Austin, B. T., Davis, C., Hindmarsh, M., Schaefer, J., & Bonomi, A. (2001) · Health Affairs · doi:10.1377/hlthaff.20.6.64 · Cited by 3,446 · cited 1×
“CCM articles by Wagner and colleagues and Bodenheimer and colleagues [8-10,14,27,28].”
Improving Primary Care for Patients With Chronic Illness
Bodenheimer, T. (2002) · JAMA · doi:10.1001/jama.288.14.1775 · Cited by 2,961 · cited 7×
“and colleagues [10], thus reflecting studies that”
BackgroundMethodInfluentialOrganizing Care for Patients with Chronic Illness
Wagner, E. H., Austin, B. T., & Korff, M. V. (1996) · The Milbank Quarterly · doi:10.2307/3350391 · Cited by 2,877 · cited 1×
“CCM articles by Wagner and colleagues and Bodenheimer and colleagues [8-10,14,27,28].”
Danaei, G., Ding, E. L., Mozaffarian, D., Taylor, B., Rehm, J., Murray, C. J. L., & Ezzati, M. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000058 · Cited by 2,860
The challenge of complexity in health care
Plsek, P. E., & Greenhalgh, T. (2001) · BMJ · doi:10.1136/bmj.323.7313.625 · Cited by 2,578
Research works printed but not linked: 3
- World Health Organization. Innovative care for chronic conditions: building blocks for action, global report. Geneva: World Health Organization; 2002.
- Public Health Agency of Canada. Chronic diseases in Canada: United Nations non-communicable disease summit. Ottawa: Public Health Agency of Canada; 2011.
- Iles V, Sutherland K. Organisational change: a review for health care managers, professionals and researchers. In: National Coordinating Center for National Health Service Delivery and Organization. 2001. p. 12–68.
Cited by
Sorted by citations
Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies
Fernandez, M. E., ten Hoor, G. A., van Lieshout, S., Rodriguez, S. A., Beidas, R. S., Parcel, G., Ruiter, R. A. C., Markham, C. M., & Kok, G. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00158 · Cited by 914
Briggs, A. M., Cross, M., Hoy, D. G., Sànchez-Riera, L., Blyth, F., Woolf, A. D., & MARCH, L. M. (2016) · The Gerontologist · doi:10.1093/geront/gnw002 · Cited by 764
A systematic review of chronic disease management interventions in primary care
Reynolds, R. C., Dennis, S. M., Hasan, I., Slewa, J., Chen, W. T., Tian, D. H., Bobba, S., & Zwar, N. A. (2018) · BMC Family Practice · doi:10.1186/s12875-017-0692-3 · Cited by 615
“The need for further research in this area is highlighted by both our finding and reviews by Kadu and Stolle [27] and Dauvrin et al. [28] who suggested that the scope of chronic care interventions should be expanded to transform health care organizations and systems.”
BackgroundResultInfluentialThe SELFIE framework for integrated care for multi-morbidity: Development and description
Leijten, F., Struckmann, V., van Ginneken, E., Czypionka, T., Kraus, M., Reiss, M., Tsiachristas, A., Boland, M. R. S., Bont, A. A. D., Bal, R. A., et al. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.06.002 · Cited by 263
“Appropriate workforce planning at organisational level is necessary and includes attention for workload and sufficient team resources [71,104,111], professional education, and sustainability of staff and informal caregivers [111].”
BackgroundRelevant models and elements of integrated care for multi-morbidity: Results of a scoping review
Struckmann, V., Leijten, F., van Ginneken, E., Kraus, M., Reiss, M., Spranger, A., Boland, M. R. S., Czypionka, T., Busse, R., & Mölken, M. R. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.08.008 · Cited by 174
Metadata
- Authors
- Kadu, M. K., & Stolee, P.
- Affiliations
- University of Waterloo (CA)
- Corresponding author
- Stolee, Paul
- Venue
- BMC Family Practice
- Published
- 2015-02-06
- Volume
- 16
- Issue
- 1
- Pages
- 12-12
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC4340610
- OpenAlex
- W2006530818
- Cited by
- 204
- References
- 64
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 11 · 2023: 16 · 2022: 12 · 2021: 38 · 2020: 40 · 2019: 23 · 2018: 11 · 2017: 15 · 2016: 11 · 2015: 5
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- University of Waterloo
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- Chronic Care Model, implementation barriers, implementation facilitators, primary care, chronic care, organizational culture, implementation climate, leadership, provider attitudes, organizational capacity
- MeSH terms
- Chronic Disease, Humans, Organizational Innovation, Patient Care Management, Primary Health Care, Organizational Culture, Models, Organizational, Needs Assessment, Quality Improvement
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