Health Providers’ Perspectives on Incorporating the Chronic Care Model into the Management of Diabetes: Findings from a Community-based Hospital in Nepal

Abstract

Background: Nepal is not adequately prepared to tackle the increasing burden of diabetes, largely due to the lack of clarity on the integration of chronic disease management into health care delivery. Clear understanding of the opportunities and challenges of incorporating proven models of chronic disease care, such as the Chronic Care Model (CCM), into diabetes management is vital for any effort to improve diabetes care. Objectives: We aimed to: 1) describe the existing approach to diabetes management in Dhulikhel Hospital (DH), a community-based hospital in Dhulikhel, Nepal; 2) identify the opportunities and challenge of incorporating the components of the CCM into diabetes management at DH; and 3) develop a comprehensive plan for incorporating components of the CCM into diabetes management at DH. Methods: This cross-sectional mixed-methods study included qualitative and quantitative data collection strategies. We administered the Assessment of Chronic Illness Care Version 3.5 to obtain the perspectives of hospital leadership (n=2) and health providers (n=27) on the status of diabetes care at DH. Following a presentation of the CCM, we conducted in-depth interviews with hospital leadership (n=2) and health providers (n=8) to obtain their perspectives of the opportunities and challenges for incorporating CCM components into diabetes care. Findings were synthesized to develop a set of recommendations. Results: The overall score for the Assessment of Chronic Illness suggested stakeholders to perceive the presence of basic support for chronic disease (overall median program score of 5.4, IQ range: 2.8) at DH. There was consensus among the participants that CCM was highly relevant and important. Almost all of them said that the existing system addressed most of the components of CCM and believed that the ongoing activities and platform of DH provided opportunities for incorporating components of CCM into diabetes management. The components of delivery system design, decision support and organization of health care were considered already present in some form. However, there were concerns from the participants in the areas of community resources, self-management support and clinical information system. Conclusion: Recommendations based on data collected here provide feasible actions that may be taken at the leadership and provider level to improve diabetes care and management in Nepal. Many of these recommendations may be relevant to other low-income countries hoping to utilize the CCM for addressing the burden of diabetes and improving patient outcomes.