چکیده (انگلیسی):

Background:The increasing prevalence of chronic disease faced by both developed and developing countries is of
considerable concern to a number of international organisations. Many of the interventions to address this concern
within primary healthcare settings are based on the chronic care model (CCM). The implementation of complex
interventions such as CCMs requires careful consideration and planning. Success depends on a number of factors at
the healthcare provider, team, organisation and system levels.
Methods:The aim of this systematic review was to systematically examine the scientific literature in order to
understand the facilitators and barriers to implementing CCMs within a primary healthcare setting. This review
focused on both quantitative and qualitative studies which included patients with chronic disease (cardiovascular
disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus, depression and HIV/AIDS)
receiving care in primary healthcare settings, as well as primary healthcare providers such as doctors, nurses and
administrators. Papers were limited to those published in English between 1998 and 2013.
Results:The search returned 3492 articles. The majority of these studies were subsequently excluded based on
their title or abstract because they clearly did not meet the inclusion criteria for this review. A total of 226 full text
articles were obtained and a further 188 were excluded as they did not meet the criteria. Thirty eight published
peer-reviewed articles were ultimately included in this review. Five primary themes emerged. In addition to
ensuring appropriate resources to support implementationand sustainability, the acceptability of the intervention
for both patients and healthcare providers contributed to the success of the intervention. There was also a need
to prepare healthcare providers for the implementation of a CCM, and to support patients as the way in which
they receive care changes.
Conclusion:This systematic review demonstrated the importance of considering human factors including the
influence that different stakeholders have on the success or otherwise of the implementing a CCM.