Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands

Abstract

Background

The Assessment of Burden of Chronic Conditions (ABCC)-tool was developed to optimise chronic care.

Objectives

This study aimed to assess the effectiveness of the ABCC-tool in patients with COPD, asthma, type 2 diabetes, and/or heart failure in primary care in the Netherlands.

Methods

The study had a pragmatic, clustered, two-armed, quasi-experimental design. The intervention group (41 general practices; 176 patients) used the ABCC-tool during routine consultations and the control group (14 general practices; 61 patients) received usual care. The primary outcome was a change in perceived quality of care (PACIC; Patient Assessment of Chronic Illness Care) after 18 months. Secondary outcomes included change in the PACIC after 6 and 12 months, and in quality of life (EQ-5D-5L; EuroQol-5D-5L), capability well-being (ICECAP-A; ICEpop CAPability measure for Adults), and patients’ activation (PAM; Patient Activation Measure) after 6, 12, and 18 months for the total group and conditions separately.

Results

We observed a significant difference in the PACIC after 6, 12, and 18 months (18 months: 0.388 points; 95%CI: 0.089–0.687; p = 0.011) for the total group and after 6 and 12 months for type 2 diabetes. After 18 months, we observed a significant difference in the PAM for the total group but not at 6 and 12 months, and not for type 2 diabetes. All significant effects were in favour of the intervention group. No significant differences were found for the EQ-5D-5L and the ICECAP-A.

Conclusion

Use of the ABCC-tool has a positive effect on perceived quality of care and patients’ activation, which makes the tool ready for use in clinical practice. Healthcare providers (e.g. general practitioners and practice nurses) can use the tool to provide person-centred care.

Trial registration number: ClinicalTrials.gov Registry (NCT04127383).

KEY MESSAGES

• The Assessment of Burden of Chronic Conditions (ABCC)-tool aims to support disease management for one or multiple chronic condition(s), currently COPD, asthma, type 2 diabetes, and heart failure.

• Statistically significant differences in patients’ perceived quality of care and patient activation were found between the group that used the ABCC-tool and the care-as-usual group. No effect was found on generic quality of life or capability well-being.

• Healthcare providers can use the ABCC-tool in primary care.

Keywords:

• Chronic conditions
• person-centred care
• self-management
• shared decision making
• general practice

Acknowledgements

We thank Sananet Care B.V. and ExpertDoc B.V. for implementing the ABCC-tool in their information systems, for their assistance during the study, and for the data on the use of the ABCC-tool. We would like to thank Stichting ZIO Zorg in Ontwikkeling for their assistance in the implementation of the ABCC-tool.

Authors’ contributions

EB, DC, AGS, MJ, and OS conceptualised the study. EB, DC, and MT were involved in the study recruitment and data collection. EB, MT, BW, SK, and MU had access to the raw data and verified the data and were involved in the data analysis. EB wrote the first draft of the manuscript. DS, OS, MT, BW, MJ, LK, SK, MU, and AGS reviewed and edited the final draft. All authors had full access to all the data in the study and accepted final responsibility for the decision to submit for publication.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethical approval

Ethical approval was obtained from the Medical Ethics Committee Zuyderland-Zuyd Heerlen, the Netherlands (METCZ20180131). All study participants signed written or electronic informed consent.

Data availability statement

The datasets have been deposited in the DataHub Maastricht Repository, under accession number 21.12109/P000000332C000000003. Parties interested in the ABCC-tool, including its specifications and requirements for incorporation in IT-systems, can contact the corresponding author of this article via email. The ABCC-tool is free of charge, on the condition of correct acknowledgement and no modifications. The availability of the ABCC-tool to the GP practice will depend on the IT-provider.

Additional information

Funding

This work was supported by the Netherlands Organisation for Health Research and Development under grant 104006001. The funders had no role in study design, data collection, data analysis, data interpretation, writing of the article, or the decision to submit the paper for publication.