Participation of general practitioners in disease management: experiences from The Netherlands.

C Spreeuwenberg,G G Van Merode,H J M Vrijhoef,L M G Steuten

doi:10.5334/ijic.49

Abstract

To investigate the extent to which GPs in The Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in The Netherlands (7680 GPs) barring those involved in the testing of the questionnaire. At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend.

Highlights

The concept of disease management has attracted considerable interest in industrialised countries w1, 2x
The factors predicting a negative attitude of Dutch general practitioners (GPs) towards disease management dominate the factors predicting a positive attitude
Eight-hundred and thirty-four of all the respondents played an active role in disease management

Summary

Introduction

The concept of disease management has attracted considerable interest in industrialised countries w1, 2x. The reasons for this are the growing number of chronically ill people, the limited capacity of health care resources as well as the focus on treating patients with a chronic disease in groups rather than separately w3x. Disease management programmes claim to deliver efficient and high quality health care services at affordable cost w4, 5x. The definition of disease management used in this study is the process of continuous improvement in the measurable outcomes of the care continuum (e.g. from prevention to reintegration) of a specific disease w6x. The building bricks for this concept are integrated and standardised care, focus on the whole continuum of care of high-cost chronic diseases, greater attention to prevention, screening and patient

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Conclusion