Attitudes to and experience of disease management programs in primary care-an exploratory survey of general practitioners in Germany.

Julian Wangler,Michael Jansky

doi:10.1007/s10354-021-00867-1

Abstract

BackgroundDisease 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.MethodsA 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.ResultsIn 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.ConclusionMost 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.Supplementary InformationThe online version of this article (10.1007/s10354-021-00867-1) contains supplementary material, which is available to authorized users.

Highlights

Establishing healthcare structures to provide better diagnosis, treatment and prevention of chronic diseases is a major challenge within the healthcare system [1,2,3]
At a figure of 57%, the majority say that, based on their own assessment and experience, disease management programs (DMPs) had been of very great (14%) or fairly great (43%) benefit for patient care (27% fairly small benefit, 11% no benefit, 5% difficult to say). 37% of respondents report that their basic attitude to DMPs had significantly (15%) or slightly (22%) improved over the past few years, in 46% it has remained the same, 17% report a moderate (11%) or significant (6%) change for the worse. 43% of doctors, especially those in more rural practices, report that they have developed a greater appreciation for DMPs in recent years; among doctors in urban areas, this figure is 31% (p < 0.001)
The findings coincide with the results of an older study from the USA, showing that three quarters of the physicians believed that DMPs increased the overall quality of patient care and the quality of care for the targeted disease [41]

Summary

Introduction

Establishing healthcare structures to provide better diagnosis, treatment and prevention of chronic diseases is a major challenge within the healthcare system [1,2,3]. In order to make healthcare more effective and efficient, disease management programs (DMPs) were established in Germany in 2003 as statutory treatment programmes in the outpatient sector, especially with a focus on primary care [4, 5]. DMPs aim to better structure treatment processes and are based on current medical knowledge as well as evidence-based guidelines with regard to specifications for diagnostics and therapy [6]. The intention is to strengthen the collaboration between the healthcare levels, for example by means of statutory job descriptions and therapy descriptions, and fixed check-up intervals [7,8,9]. Consistent recording of all examination and treatment results serves to coordinate individual healthcare steps, so that unnecessary duplication of investigations or examinations can be avoided

Methods

Results

Discussion

Conclusion