A Guide for Chronic Disease Management: The Chronic Care Model

Incirkus K., Nahcivan N. O.

FLORENCE NIGHTINGALE JOURNAL OF NURSING-FLORENCE NIGHTINGALE HEMSIRELIK DERGISI, cilt.23, sa.1, ss.66-75, 2015 (ESCI İndekslerine Giren Dergi) identifier identifier identifier

  • Cilt numarası: 23 Konu: 1
  • Basım Tarihi: 2015
  • Doi Numarası: 10.2196/jmir.3547
  • Sayfa Sayıları: ss.66-75


Currently the increasing prevalence of chronic diseases reveals the importance of chronic disease control and community-based disease management programs. Chronic disease management; is an important and practical method especially in providing the coordination and continuity of care, promoting teamwork, improving the quality of chronic disease care and patient outcomes, reducing the costs of care. Despite the various models for chronic disease management been offered, the most widely used and most effective acceptable is the Chronic Care Model. The model developed by Wagner et al, generally defines six major components. These are: (1) Community resources and policies, (2) Decision support, (3) Organization of health care, (4) Self-management support, (5) Delivery system design and (6) Clinical information systems. Model, accordance with the six components which are connected with each other, is designed to improve patients results of health/care. Instead of traditional treatment and care approach, increasing knowledge and awareness about patient-centered, multi-disciplinary and evidence-based approaches is important for the successful chronic disease management. In this review article, aimed to present the Chronic Care Model as a guide in chronic disease management and advise for using of the model in chronic disease management for the health professionals (especially for nurses) working with patient which have chronic diseases.