RESEARCH ARTICLE Open Access Facilitators and barriers of implementing the chronic care model in primary care: a systematic review Mudathira K Kadu and Paul Stolee * Abstract Background: The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. Methods: This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. Results: This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. Conclusions: These findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers’ and organizational perspective. Keywords: Chronic care model, Chronic diseases, Primary care, Quality improvement, Intervention implementation, Organizational change Background The prevalence of chronic diseases is globally on the rise, with cardiovascular diseases, respiratory disease, diabetes, cancer, and other chronic illnesses being major contributors to disability [1,2]. In Canada, two out of five people have at least one chronic disease. Chronic disease is a major driver of health care expenditure, reaching approximately $68 billion in Canada in 2010 [3]. The current health care system is oriented towards episodic and acute care, making it unprepared to address the multi-faceted and complex needs of those with chronic diseases [4,5]. Given the need for continuity, compre- hensiveness and coordination, primary care has been suggested as potentially playing a central role in effective management and integration of care [6]. However, litera- ture on current practice suggests that patients often receive inadequate care, with limited physician involvement in * Correspondence: stolee@uwaterloo.ca School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada © 2015 Kadu and Stolee; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kadu and Stolee BMC Family Practice (2015) 16:12 DOI 10.1186/s12875-014-0219-0