PT  - JOURNAL ARTICLE
AU  - Aline Ramond-Roquin
AU  - Maud-Christine Chouinard
AU  - Bayero Boubacar Diallo
AU  - Tarek Bouhali
AU  - Sylvie Provost
AU  - Martin Fortin
TI  - Chronic disease prevention and management programs in primary care
DP  - 2019 Aug 01
TA  - Canadian Family Physician
PG  - 559--566
VI  - 65
IP  - 8
4099  - http://www.cfp.ca/content/65/8/559.short
4100  - http://www.cfp.ca/content/65/8/559.full
SO  - Can Fam Physician2019 Aug 01; 65
AB  - Objective To identify the mechanisms associated with success and failure of chronic disease prevention and management (CDPM) programs, as well as their key contexts.Design Realist synthesis.Setting Six primary care CDPM programs funded between 2011 and 2013 in Quebec.Participants Patients, health providers, program leaders, and other stakeholders involved in CDPM programs.Methods A collaborative research process was implemented, involving representatives from the executive and advisory committees: researchers, health care providers, decision makers, and patients and families. Leaders were asked to provide all documents related to their programs to the research team. The documents were selected depending on their relevance and rigour. The thematic analysis of each program consisted of identifying the outcomes and mechanisms, as well as the specific contexts associated with these outcomes. Results for each program were validated by its leader before synthesizing the results of all programs together.Main findings A total of 108 documents (eg, grant applications, scientific reports) were collected from the programs. Positive and negative outcomes were observed at the patient, health care provider, and health care system levels. Four main mechanism categories were associated with outcomes: patient-centred interdisciplinary care; self-management support and a motivational approach; professional support; and care coordination and relationships with partners. The main contextual factors that influenced the successes of these mechanisms were related to patients (multimorbidity, involvement of family caregivers), to health care providers (professional training, culture of interprofessional collaboration, mobilization of family physician), and to health care organizations (coordination between services, history of collaboration between partners, funding).Conclusion This study confirms the essential role of patient-centred interdisciplinary care; self-management support and a motivational approach; professional support; and care coordination and relationships with partners when caring for patients with chronic diseases. It constitutes a relevant contribution for stakeholders involved in primary care transformation and should be used to inform the sustainability and scaling up of CDPM programs.