Rethinking care for chronic conditions
Anna Askerud's research shows that new models of care for those with chronic conditions need to consider social determinants.
Client Led Integrated Care (CLIC) is a model of care specifically for people with multiple chronic conditions. It is based on the principles of the global recognised Chronic Care Model and was envisaged as a proactive programme based on best-practice guidelines. One of its goals was to reduce health inequities, particularly for Māori, Pacific people, vulnerable older adults, and those living in poverty. Another significant aim was to provide appropriate levels of care to reduce demand on hospitals.
Our assessment during the four years since the programme was implemented in general practices in the southern district of Aotearoa, from 2018 to 2022, shows that CLIC has not been effective in reducing health inequities. The reason CLIC has not worked uniformly is because people’s ability to manage their health is complex. Social determinants of health – including income and job security, education, housing and food insecurity, social inclusion and non-discrimination – influence outcomes.
In order to improve health outcomes for everyone, Aotearoa New Zealand needs radical rethinking to provide more than standard models of care. Key changes include the removal of barriers such as patient fees for primary care services, and providing alternatives to nine-to-five clinic consultations. Incorporating family, social and community connections to support people to improve their health and their social circumstances is also a valuable strategy. It is crucial such programmes consider individual life circumstances and people’s capability and access to resources (or the lack thereof) to manage their health.