Project managers stated that this change in thinking reflected a shift from Birinapant solubility dmso the provision of general advice to a focus on patient-centered and mutually agreed upon targets identified by patients, rather than professionals. This was a move, as indicated above, away from

one standard approach toward personalized plans to change health behaviors. This not only led to the systematic change that professionals allied to the GP then monitored patients’ progress toward achieving these goals, but also to the approach mentioned by Project Manager B that the patient is in the lead and the professional takes a more neutral, assisting position in the efforts to change health behavior. The aforementioned monitoring process reflects the expansion of communication within DMPs, from a one-on-one provider-patient interaction during an annual check-up to communication among multiple caregivers in regular contact with patients at the individual and group levels. Project managers Fluorouracil clinical trial stressed the importance of group contact because patients could learn from and support one another: “I can say that someone needs to stop smoking, but at the point where patients are able to say it to one another, it works much better than with my finger pointing at them. And that’s the great part [about the program].” (Project Manager C); and As the quote from

Project Manager A reflects, professionals recognize that social accountability and community involvement also play important roles in the management of chronic diseases. They therefore worked to create such opportunities through the DMPs, which reflected further innovation in communication by also expanding interactions beyond the practice in order Phospholipase D1 to improve patient care. This means that practices developed new attempts to connect with patients’ everyday worlds, for example, through a community meeting with patients and creating opportunities for networking (e.g., with sports clubs, support groups, and community leaders): “We are working hard

to establish a network with a large group of people in the city who are already involved in sport, diet, physical and manual therapy, but also with other types of interest groups, such as the homeowner’s association. (…) So we had a network meeting and introduced ourselves as the organizers of a health market. We invited them to join us and divided them into four areas (such as measuring different physical values) that people could visit.” (Project Manager E). Beyond changes in direct communication, the project managers also mentioned aspects of DMPs that may not have been evident to patients. Some practices invested in improving or expanding their ICT systems to improve patient tracking: “We were not anywhere close to having a good overview of all the patients. Now we use our information system to send reminders to come in for a check-up. We developed a good coding system and make sure that individual records are coded properly.