Chronic Condition Self-Management: A primary health care change management problem

Abstract

Australian general practitioners are recognising the need to implement some form of chronic condition management program to better service and cope with the ever-increasing number of patients presenting with chronic conditions. Chronic Condition Self-Management (CCSM) is one such program. In this paper it is argued that the basis of CCSM is a multi-disciplinary, care-team approach, and that implementation of such an approach represents a paradigm shift in primary health care service delivery. This equates to a significant innovation in primary health care service that, in economic terms, aims to increase primary health care outputs. Although general practitioners are at the centre of the change they cannot implement the change without the participation and collaboration of the other stakeholders. These stakeholders include other health service providers, the Divisions of General Practice, the Department of Health and Ageing, and the patient. This paper presents a general practice business model to illustrate the relationships between stakeholders in the primary health care sector and to identify the impact of CCSM on these relationships. The organisational and business issues that need to be addressed to promote the uptake of CCSM are also identified.