Chronic disease management in medical institutions in Latvia requires significant improvements

The objective of this study is to assess chronic disease management in medical institutions in Latvia and to identify aspects for improvement. A survey tool was developed based on the Patient-centered medical home assessment (PCMH-A) instrument related to Chronic Care Model (Wagner,2009) for secondary and tertiary care providers. Respondents (N= 34) rated their practice at 4 levels (D, C, B, A) with assigned rates from 0 to 3 (highest level) characterizing the implementation level in 4 areas (33 questions): organization, collaboration outside health care system, currently implemented practice and integration of chronic care components. The management of chronic patients in health care institutions in Latvia is rated at low level: none of the areas exceeded 38% of the highest performance possible. The organization of services for chronic care patients is evaluated at the level of 38%, organization’s collaboration outside health care system at 27.2%, currently implemented practice for patient centered care – 21.95% and integration of chronic care components - 25% level. Chronic disease management in medical institutions requires improvements related to setting clear organizational goals,, collaboration outside the health care system, wider use of clinical information systems, systemic patient clinical monitoring, multidisciplinary approach and support for patient self-care. The development of individual patient care plans and collaboration between primary and secondary care teams is crucial for the success.