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Evaluation of Health Professional Training on a Large-Scale Implementation of Chronic Care Model in Primary Care Settings of a Middle-Income Country

Author(s): Paibul Suriyawongpaisal, Samrit Srithamrongsawadi, Vorasith Sornsrivichai, Thanita Thongtan


Background: The evidence on the effects of the Chronic Care Model (CCM) intervention in low- to middle- income countries is limited. A recent policy initiative in Thailand to improve care for patients with non-communicable disease focuses on strengthening primary care through the allocation of family medicine physician and multidisciplinary primary care training and allocation failed to demonstrate any changes in knowledge and skills of the trainees.

Aim: Our study aims to examine the effects of provider training and local health systems settings on provider perception of implementing CCM for patients with diabetes or hypertension in Thailand.

Methods: We conducted a cross-sectional survey of 1,064 multiprofessional providers in 128 primary care units in large and small municipalities from 11 provinces in Thailand using a self-administered questionnaire modified from the assessment of chronic illness care (ACIC) form. Responses fall within four descriptive levels D, C, B, A of implementation ranging from D "little or none" to A "fully implemented" intervention. Generalized linear models were employed to compare provider perception of implementing CCM between trained pilot PCUs, pilot PCUs, ordinary PCUs, and NCD clinics.

Results: Generalized linear models depicted an independent association between every CCM component and facility type with respondents of trained pilot PCU reporting the highest estimated marginal mean (EMM) scores (p<0.001). Statistically significant differences in the scores between health facilities in small and large municipalities were found in almost all components (p<0.01).

Conclusions: Policymakers might find the training approach promising in context with extensive universal healthcare coverage and relatively strong healthcare infrastructure like Thailand. In addition, modified ACIC in our study might be useful to assess and monitor the progress of the training in primary care settings. Further studies are needed to ascertain the effectiveness of the training using patient assessment and outcomes as indicators.