Who benefits most in disease management programs: Improving target efficiency

Summary Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.

Download Full-text

Using an Empirical Method for Establishing Clinical Outcome Targets in Disease Management Programs

Disease Management ◽

10.1089/1093507041253280 ◽

2004 ◽

Vol 7 (2) ◽

pp. 93-101 ◽

Cited By ~ 8

Author(s):

Ariel Linden ◽

John L. Adams ◽

Nancy Roberts

Keyword(s):

Disease Management ◽

Clinical Outcome ◽

Empirical Method ◽

Disease Management Programs

Download Full-text

Disease Management Programs for Heart Failure

Current Treatment Options in Cardiovascular Medicine ◽

10.1007/s11936-010-0094-5 ◽

2010 ◽

Vol 12 (6) ◽

pp. 578-586 ◽

Cited By ~ 4

Author(s):

Ken McDonald

Keyword(s):

Heart Failure ◽

Disease Management ◽

Disease Management Programs

Download Full-text

The Chronic Care Model Versus Disease Management Programs

Health Care Management Review ◽

10.1097/00004010-200601000-00004 ◽

2006 ◽

Vol 31 (1) ◽

pp. 18-25 ◽

Cited By ~ 10

Author(s):

Jennifer Leeman ◽

Barbara Mark

Keyword(s):

Disease Management ◽

Chronic Care Model ◽

Chronic Care ◽

Care Model ◽

Disease Management Programs ◽

Model Versus

Download Full-text

Participation in Disease Management Programs and Major Adverse Cardiac Events in Patients After Acute Myocardial Infarction.

10.21203/rs.3.rs-25395/v1 ◽

2020 ◽

Author(s):

Christian Fischer ◽

Jens Höpner ◽

Saskia Hartwig ◽

Michel Noutsias ◽

Rafael Mikolajczyk

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Disease Management ◽

Cardiac Rehabilitation ◽

Lower Risk ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Disease Management Programs ◽

Cardiovascular Morbidity And Mortality ◽

Adverse Cardiac Events

Abstract Background Cardiovascular diseases are still the main cause of death in the western world. However, diminishing mortality rates of acute myocardial infarction (AMI) are motivating the need to investigate the process of stationary and ambulatory secondary prevention after AMI. Besides cardiac rehabilitation, disease management programs (DMPs) are an important component of outpatient care after AMI in Germany. This study aims to analyze outcomes after AMI among those who participated in DMPs and stationary cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: On the basis of data from a regional myocardial infarction registry and a 2-years follow up period, we assessed the occurrence of major adverse cardiac events (MACE) in relation to participation in CR and DMP, risk factors for complications and individual health, and lifestyle characteristics. Multivariable Cox regression was performed to compare survival time until an adverse event occurred.Results Out of 1,094 observed patients AMI, 272 were enrolled in a DMP. A weak association between DMP participation and hazard rates for MACE compared to non-enrollees was found in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65–1.33). When adjusted for possible confounders, this difference disappeared (1.03; 0.72–1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, participants of CR showed a lower risk for MACE in crude (0.52; 0.41–0.65) and adjusted analysis (0.56; 0.44–0.71).Conclusions Participation in DMP was not associated with a lower risk of MACE, while CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, still potential effects of confounding need to be considered.

Download Full-text