Managing the Chronic

This thesis is based on research conducted on twenty-two disease management programs in the Netherlands. These programs were predominantly based in primary care facilities and focused on chronic diseases including diabetes, COPD, risk of cardiovascular disease, mental health issues, or co-morbidity for patients with multiple chronic diseases. The disease management programs were carried out by teams of clinicians and were supported by internal and external communication and chronic disease experts. As part of the programs, patients were invited to participate in extra educational sessions, offered additional appointments to discuss their concerns with their chronic disease, and/or given access to their medical record via an online patient portal; through the disease management programs, much emphasis was put on partnering with patients to manage their chronic disease. To understand how these disease management programs worked in practice, I conducted interviews with clinicians, patients, and external supporters; I also conducted online data collection of a patients’ support website to get further observations and deeper insight into the lives of those with a chronic disease. This research uncovers how the programs changed the lives of those who participated in them, and how disease management programs changed care in the programs. It also reveals how the research program that ran alongside the disease management program impacted healthcare delivery.