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International Journal for Quality in Health Care Advance Access originally published online on April 22, 2009
International Journal for Quality in Health Care 2009 21(4):233-242; doi:10.1093/intqhc/mzp017
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© The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Professional commitment to changing chronic illness care: results from disease management programmes

Karin Lemmens, Mathilde Strating, Robbert Huijsman and Anna Nieboer

Institute of Health Policy and Management, Erasmus University Medical Center, PO Box 1738, Rotterdam 3000 DR, The Netherlands

Objectives. The aim of this exploratory study was to investigate to what extent primary care professionals are able to change their systems for delivering care to chronic obstructive pulmonary disease (COPD) patients and what professional and organizational factors are associated with the degree of process implementation.

Design. Quasi-experimental design with 1 year follow-up after intervention.

Setting. Three regional COPD management programmes in the Netherlands, in which general practices cooperated with regional hospitals.

Participants. All participating primary care professionals (n = 52).

Intervention. COPD management programme.

Main Outcome Measures. Professional commitment, organizational context and degree of process implementation.

Results. Professionals significantly changed their systems for delivering care to COPD patients, namely self-management support, decision support, delivery system design and clinical information systems. Associations were found between organizational factors, professional commitment and changes in processes of care. Group culture and professional commitment appeared to be, to a moderate degree, predictors of process implementation.

Conclusions. COPD management was effective; all processes improved significantly. Moreover, theoretically expected associations between organizational context and professional factors with the implementation of COPD management were indeed confirmed to some extent. Group culture and professional commitment are important facilitators.

Keywords: disease management, quality improvement, primary care, organizational innovation, professional practice

Address reprint requests to: Karin Lemmens, Institute of Health Policy and Management, Erasmus University Medical Center, PO Box 1738, Rotterdam 3000 DR, The Netherlands. Tel: +31-10-40-88-541; Fax: +31-10-40-89-094; E-mail: k.lemmens{at}erasmusmc.nl

Accepted for publication March 30, 2009.


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