چکیده (انگلیسی):

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.