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Background: The rising burden of chronic illness represents major challenges for our current health-care systems. Generally, our current health care system mainly focuses on an acute care management and short-term goals; particularly our Primary Health Care System, which is uninformed, fragmented, and poorly coordinated to meet the needs of chronically ill patients. This study proposes the use of Chronic Care Model (CCM) which is a systematic; an evidence-based framework for improving chronic illness care in primary health care setting, but little is known and the potential benefits of doing so were missed. Objective: This study aims to describe the extent to which Addis Ababa City Administration primary health care system supports for chronic illness care with the Wagner Chronic Care Model and identify any strengths, weaknesses, barriers, and opportunities in the health care management practice to improve health outcomes. Methods: Institution based cross-section survey was conducted in selected Addis Ababa City publichealth centers tailored for prevention and control of chronic illness by the government model. Using the CCM as a framework, face to face open-ended interview with health center staff were conducted to describe the extent to which it‟s consistent& identify successes and barriers that influence a successful uptake in the primary health care system. Data were collected qualitatively using semi structured interview questioner in relation to version 3.5 of the ACIC scale, and organized with a SWOT analysis matrix. An analysis was by computer aided qualitative data analysis software open code. Results: Chronic care tailored health centers developed little to basic stage of support and had distinct areas of Strengths and weaknesses in each six component of the system: 1) organizational support -strengthened by working together with partner ( Psi-Ethiopia Healthy Heart Africa initiative), established performance monitoring team and provides training in disease management, but weakened by lack of explicit chronic care goals, was not reflected in their business plan and there is also a lack of funding to support activities related to chronic illness care; 2) community linkages- strengthened by established community visiting team ( Family health team),but detracted by lack of participation of community-based organizations, less priorities chronic disease care in their care plan and poor sense of program ownership by health managers; 3) self-management-promoted through one to one patient education and risk factor assessment for clients, but impeded by limited focus on family and community-based educational activities and seldom set goals with clients for assessed need; 4) decision support-facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design-strengthened by appointment of designated chronic disease coordinators, effective teamwork and provision of clinic rooms, but weakened by lack of defined roles and responsibilities to heath care workers in relation to chronic illness care and suffered from a shortage of staffs especially doctors, behavioral health professional, case manager and counselors; 6) clinical information systems-strengthened by easily accessible, organized patient records, recalls and timely feedback but, limited by lack of computerized systems adoption and capacity to supply population based information for quality of chronic illness care. Conclusion: This study identified several strengths and weaknesses and determined the extent to which we handled a chronic illness care by using standard protocol, a CCM framework which might be useful in assessing and guiding development of system for improvement of chronic care in primary health centers. An adaptation of the CCM model may serve as a template for future health care system redesigning & help to improve access to quality and effective health care services especially in primary healthcare. |
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