Older adults in Kosovo face multilayered socioeconomic challenges that shape chronic disease management, yet the interaction between health literacy, economic constraints, and self-management remains insufficiently documented.To examine the relationship between health literacy, socioeconomic barriers, and chronic disease self-management among older adults in Prishtina, Kosovo.A mixed-methods survey was conducted among 89 older adults in Prishtina. Health literacy was assessed using the HLS-EU-Q16, chronic disease self-management using the SC-CII, and open-ended questions explored participants’ perceived needs and barriers.Although 47.8% of participants demonstrated adequate health literacy, socioeconomic constraints dominated health-related experiences. The most frequently reported unmet needs were cost-free medication (34%) and financial assistance (28%). Many participants linked their ability to manage chronic conditions directly to pension adequacy and out-of-pocket healthcare costs. Regression analyses indicated that, even after controlling for health literacy, individuals with “other” chronic conditions—often requiring expensive or specialised care—had significantly lower self-management scores (B = −7.25, p = 0.038). Qualitative findings further revealed that economic stress undermines long-term disease management, often outweighing knowledge or motivation.The findings suggest that the potential benefits of health literacy are constrained when older adults face persistent financial hardship, highlighting the limits of individual-level interventions in the absence of structural support. Weak social protection mechanisms, high out-of-pocket payments, and fragmented care pathways within the healthcare system further exacerbate inequalities in chronic disease management. In this context, health literacy initiatives must be embedded within a responsive healthcare system that ensures continuity of care, equitable access to services, adequate consultation time, and coordinated support across health and social sectors.Health literacy alone is insufficient to ensure effective chronic disease self-management when socioeconomic barriers are substantial. Policymakers should prioritize strengthening the healthcare system through improved financial protection, affordable medication coverage, integrated primary care models, and age-sensitive service delivery. Aligning health literacy strategies with broader health and social policies is essential to create enabling environments for self-management, reduce inequities, and promote healthy, dignified ageing in Kosovo.

In people with chronic conditions, monitoring is an important part of their healthcare. However, many monitoring procedures have developed historically and only limited evidence is available. This project created a framework to set out requirements for the development or evaluation of monitoring procedures.The aim of the framework is to guide the process of developing or evaluating evidence for monitoring procedures.The framework was based on a scoping review that examined the evidence methods used to evaluate monitoring. The results were used to develop an initial draft, which was then presented at an international expert meeting. The feedback contributed to further develop the framework. The next draft was then sent to all experts for comments. The process was repeated in two further rounds.Monitoring is only useful if four conditions are met: (1) clinically significant findings with a negative impact on disease-specific, patient-relevant outcomes occur over time; (2) treatment or preventive measures are available to address these clinically relevant findings; (3) valid, acceptable and affordable tests are available to detect these changes; (4) potential benefits and harms of the monitoring procedures have been considered and benefits outweigh harms. A step-by-step approach will then be used to obtain evidence for the individual components of a monitoring routine. This includes selection of target group and patient-relevant outcomes, selecting predictors with strong associations with these outcomes, determining appropriate treatment actions following monitoring results, selecting high-quality tests and defining target ranges, determination of further diagnostic actions, deciding monitoring intervals, and defining the best suited actor or setting for the completion of monitoring procedures. Patients with lived experience should be included in all steps of the process. A checklist was developed to guide the process.The framework provides a structured approach and can be used either to develop guideline recommendations or studies that evaluate monitoring routines. The stepwise process is guided by principles of patient involvement, patient-centred healthcare and scientific research. In a next step, the framework should be tested for different chronic conditions including simple and complex monitoring procedures.The ChroMo framework can support the development of guideline recommendations for monitoring procedures.

Medication adherence is essential for effective chronic disease management in primary care. Behavioral factors, patient-reported barriers, and treatment complexity strongly influence adherence. Evidence from chronic disease follow-up outpatient clinics, which typically serve older and multimorbid patients, is limited. This study presents preliminary findings from an ongoing investigation assessing adherence and related factors in this setting.This study aims to measure medication adherence among adults attending a chronic disease follow-up outpatient clinic, identify patient-reported difficulties affecting adherence, and examine demographic, clinical, and behavioral factors associated with adherence.This ongoing cross-sectional study includes adults using long-term medications for chronic diseases. Data are collected through face-to-face interviews using a structured questionnaire assessing sociodemographic characteristics, chronic conditions, medication burden, digital reminder tool use, alternative medicine practices, and patient-reported difficulties. Medication adherence is measured with the 12-item Medication Adherence Questionnaire (score range 12–48). Descriptive statistics, chi-square tests, t-tests, and correlation analyses were conducted. Recruitment is ongoing; this abstract reports interim findings from 109 participants.The mean age was 57.6±14.1 years; 53.2% were female and 38.5% were aged ≥65 years. Hypertension (66.1%) and diabetes (51.4%) were the most common chronic conditions. The mean adherence score was 39.7±6.2; 75.2% showed high adherence and 24.8% moderate adherence. Despite high adherence, 55% reported at least one medication-related difficulty, most commonly forgetfulness (25.7%) and financial concerns (17.4%). Although nearly all participants owned a smartphone (96.3%), only 8.3% used digital reminders. Adherence did not differ significantly by age, sex, education level, or medication count. Participants with COPD and those reporting difficulties showed slightly lower adherence scores, though differences were not statistically significant.Interim findings show high adherence despite frequent patient-reported difficulties. Forgetfulness and financial concerns suggest vulnerability even among highly adherent patients. Extremely low use of reminder tools, despite universal smartphone access, highlights a feasible target for intervention. Continued recruitment and multivariable analyses will help identify subgroups at greater risk of reduced adherence.This ongoing study indicates that patients generally maintain high adherence yet face modifiable challenges. Simple supportive strategies, such as digital reminders, may help address common barriers. Final results will inform targeted adherence-support interventions in primary care.

Enhancing patient-centred care requires robust mechanisms to capture the patient perspective on disease management. The validated Patient Experience for Disease Management Scale (PEDMS) provides a multi-dimensional assessment, but its utility in clinical practice is contingent upon a clear implementation and interpretation framework.This study presents a structured methodology for the clinical application of the PEDMS, demonstrating how its domain-specific scores can be utilized by primary care teams to identify discrete areas of strength and deficiency in care processes, thereby facilitating targeted quality improvement and reinforcing the therapeutic partnership.The PEDMS is 38-item instrument encompassing eight domains: Reassurance and Explanation; Advice and Counselling; Prescribing; Red Flags and Referral; Investigation; Observation and Follow-up; Prevention and Promotion; and Patient’s Wants, Needs, and Satisfaction. Respondents indicate their agreement on a five-point Likert scale. We delineate a systematic protocol for its application: (1) administration following clinical consultations, (2) calculation of mean scores (range 1-5) for each domain, and (3) analytical interpretation of scores to guide service enhancement. The psychometric integrity of this structure (CFI=0.965, RMSEA=0.067, Cronbach's α=0.878) underpins its reliability for this purpose. Application of the PEDMS yields a detailed profile of patient experience across the core domains of disease management. Domain scores facilitate immediate analysis: elevated scores (approaching 5) signify clinical strengths, while attenuated scores (approaching 1) pinpoint specific care delivery shortcomings. For instance, a high score in "Prescribing" concurrent with a low score in "Advice and Counselling" objectively identifies effective medication management alongside an unmet need for behavioural support, transforming subjective feedback into actionable intelligence.The PEDMS offers a structured approach to convert patient feedback into actionable strategies for clinical improvement. By moving beyond generic satisfaction metrics, it enables precise interventions that enhance the clinician-patient relationship. The tool highlights disparities in care experiences, promoting equity, and equips practitioners with data to advocate for meaningful changes aligned with patient priorities.The PEDMS, alongside this implementation framework, is essential for advancing patient-centered care in primary settings. Its systematic use allows clinicians to efficiently identify and address gaps in disease management, contributing to more responsive and equitable healthcare systems.

Rheumatoid arthritis (RA) is a major cause of long-term disability and reduced quality of life. While rheumatology services deliver specialist management, primary care plays a vital role in continuity, patient-centred follow-up, and long-term disease monitoring. NICE provides guidelines on a comprehensive annual review, including an assessment of functional ability, comorbidity risk, and complications. General practitioners (GPs) are well-equipped to deliver personalised care by addressing the patient’s unique needs, concerns, and preferences. By engaging in patient education and shared decision-making, patients are empowered to take an active role in managing their own health. Additionally, the GP’s holistic approach facilitates access to social care, caregivers, and council services – addressing wider emotional and social determinants of health.This audit reviews the existing clinical practice for RA annual reviews compared to the NICE guidelines. It particularly focuses on identifying opportunities to enhance medication adherence, comorbidity detection, and holistic follow-up.Forty-seven patients were randomly reviewed for documentation of annual RA monitoring, comorbidity screening, and complications. Functional ability was assessed using a Health Assessment Questionnaire (HAQ), which was completed by 24 patients over the telephone.Only 5 patients had a coded annual RA review. CVD risk screening was consistent; however, osteoporosis and depression screening were under-recorded. Only 15% of patients underwent all three risk assessments. The mean HAQ score was 2, indicating moderate functional disability. Approximately 10% of patients had no contact with the practice despite repeated outreach.This audit highlights multiple challenges specific to primary care. A high workload, competing long-term conditions, and tight time constraints limit the depth of review, reducing opportunities for thorough, patient-centred follow-up. Non-attendance further restricts the clinician’s ability to identify deterioration early. Addressing health literacy and patient education is crucial in combating this issue. The HAQ revealed functional decline that was not clear in routine consultations. This highlights the value of structured assessments in unmasking unmet needs. These, however, are time-consuming, exaggerating the time bottleneck that GPs already face.Delivering holistic care through better patient education, improved comorbidity screening and technology implementation through pre-appointment digital HAQs, will vastly improve RA follow-up in primary care.

Inhalers containing bronchodilators and corticosteroids are the cornerstone of COPD pharmacotherapy. Adherence to prescribed medication is critical to successful management.We studied inhaler adherence in a large cohort of COPD patients in Israel, to assess the effect of specific inhaler devices and medications on adherence.We performed a retrospective cohort study in Clalit Health Service (CHS), an HMO serving >50% of the population of Israel. CHS members aged 40-80 years with a diagnosis of COPD, who filled ≥1 prescription/year 2017-2019 (regular users) for at least one inhaler containing long-acting beta-adrenergics (LABA), long-acting anti-muscarinics (LAMA) and/or inhaled corticosteroids (ICS), were included. Filled monthly prescriptions were used as a proxy for actual medication use. The primary endpoint was the proportion of adherent users (purchase of ≥7 inhalers/yr in 2018).20,413 COPD patients (age 68.4±7.1 yrs. 58% men, 87% ever smokers) were identified. Of 11,422 regular inhaler purchasers (56% of total), only 6,771 (59%) were adherent. Increasing age, male gender, better socio-economic status and smoking history were significant predictors of good adherence. Good adherence was more common for inhalers including LAMA. There were significant differences in adherence between inhaler devices. Adherence to once-daily inhalers appeared to be better than twice daily inhalers. Patients with good adherence were more likely to experience exacerbations, to be hospitalized and to die.45% of the total COPD patients included in the study did not receive regular long-acting inhaler therapy. This is worrisome and suggests a need for better care for COPD patients.Adherence to inhalers in COPD patients was associated with the drug class, inhaler device, and recommended frequency of use. Adherence was associated with worse outcomes, suggesting sicker patients are more adherent

As part of the transformation of the healthcare system, XXX  has developed a new model of care for people with chronic conditions through the Planificat programme, a pioneering initiative within the field of primary health care. Progressively implemented since 2022 in 283 Primary Care Centres, the programme aims to improve health outcomes and enhance the teams’ ability to address complex cases, using a methodology grounded in scientific evidence and adapted to the specific characteristics of each territoryPlanificat promotes a paradigm shift in the management of chronic conditions, focusing on equity, proactivity, and planning. Despite territorial inequalities in terms of resources and organisation, its inherent flexibility and adaptability have greatly facilitated its implementation, allowing each team the freedom to adjust the model to its local realityThe experience has highlighted the importance of clinical leadership, multidisciplinary collaboration, and professional cohesion. The active engagement of teams and their ability to adapt to available resources have been decisive factors in the success of the projectThe results obtained show improvements in the identification and follow-up of people with chronic diseases, in performing annual check-ups, in the management of risk factors, and in patient satisfaction. Nonetheless, certain challenges remain, such as ensuring the sustainability of the model, consolidating a culture of change, achieving territorial equity in access, and strengthening coordination between different levels of carePlanificat represents a strategic commitment to reinforcing primary care as the backbone of the healthcare system. Its originality, impact, and adaptability position it as a benchmark for future health policies, contributing to more efficient, equitable, and person-centred care. The current challenge lies in guaranteeing its scalability and sustainability, ensuring its full integration within XXX overall chronic care strategy.