A national survey of chronic disease management in Irish general practice.

It is timely to look at how we deliver chronic disease care in General Practice, and also to consider what aspects of this we may care to change, to augment, to dispense with, or to maintain. The Chronic Care Model has broad international acceptance as a model to provide guidance on the shift from our current predominantly acute and episodic model of care to a lifelong model of promotion, prevention, early intervention and chronic care. The Chronic Care Model encompasses both non-communicable disease such as diabetes, heart disease, chronic obstructive pulmonary disease, cancers and depression and communicable diseases such as AIDS, and sometimes tobacco, alcohol and problem drug use are included. The core elements revolve around organizational changes in health care delivery – better connected teams with clinical informatics and decision support, proactive planned care around evidence, and patient and care giver specific needs with greater support for self-care. Many countries are engaged in the transition to a Chronic Care Model. These range from the West including the US, Europe, Canada, Australia, New Zealand,as well as Ireland to the developing world including China, India and South East Asia. However the transition in well established systems is difficult to make if initiatives are ‘top down’, particularly without patient centred approaches and physician leadership or active involvement. This study provides a baseline of the provision of chronic disease management in Irish general practice in 2010. • It compares Ireland to survey data of primary care physicians in 11 countries, allowing Irish general practice to be measured against international counterparts. • The study achieved a 72% response rate. • 63% of GPs believe that there are some good things in our health service but significant changes are needed to facilitate the management of chronic care. • GPs reported wide use of information technology systems within the practices. • 99% of respondents indicated that they provide an out-of-hours service for their patients, which places Ireland as the leader of provision of access for patients outside of surgery hours, compared to their international counterparts. • A small number of routine clinical audits are being performed. • Irish GPs use evidence based guidelines for the treatment of diabetes, asthma or COPD and hypertension, to the same frequency as their international counterparts. • The main barriers to delivering chronic care are an increased workload and a lack of appropriate funding for chronic disease management. • GPs are interested in targeted payments for the management of chronic disease. • 36% of respondents indicated that their practice was functioning as a part of a primary care team. • GPs’ perceptions indicate that they believe substantial differences remain between fee-paying patients and GMS entitled patients in terms of access to diagnostic tests, longer waiting times to see a hospital based specialist and longer waiting times to receive treatment after a diagnosis. • GPs perceive that their fee-paying patients experience difficulties in paying for medications and other out-of-pocket expenses. • GPs support the concept of shared care initiatives between themselves and local hospitals