Effectiveness of the German disease management programs: quasi-experimental analyses assessing the population-level health impact

Background In 2002–2003 disease management programs (DMPs) for type 2 diabetes and coronary heart disease were introduced in Germany to improve the management of these conditions. Today around 6 million Germans aged 56 and older are enrolled in one of the DMPs; however, their effect on health remains unclear. Methods We estimated the impact of German DMPs on circulatory and all-cause mortality using a synthetic control study. Specifically, using routinely available data, we compared pre and post-intervention trends in mortality of individuals aged 56 and older for 1998–2014 in Germany to trends in other European countries. Results Average circulatory and all-cause mortality in Germany and the synthetic control was 1.63 and 3.24 deaths per 100 persons. Independent of model choice, circulatory and all-cause mortality decreased non-significantly less in Germany than in the synthetic control; for the model with a 3 year time lag, for example, by 0.12 (95%-CI: − 0.20; 0.44) and 0.22 (95%-CI: − 0.40; 0.66) deaths per 100 persons, respectively. Further main analyses, as well as sensitivity and subgroup analyses supported these results. Conclusions We observed no effect on circulatory or all-cause mortality at the population-level. However, confidence intervals were wide, meaning we could not reject the possibility of a positive effect. Given the substantial costs for administration and operation of the programs, further comparative effectiveness research is needed to clarify the value of German DMPs for type 2 diabetes and CHD.

Chronic Disease Management Programs Based On Caring Theory With Blood Pressure Reduction

Background: Hypertension cases to overcome the patient's hypertension condition would be well or prosperous condition and the patient could prevent complications and control blood pressure. Activities in Chronic Disease Management Program (Prolanis) include medical or educational consultations, home visits, reminders, club activities.Purpose: This study aimed to analyze the application of the prolanis program based on the caring theory by reducing blood pressure in hypertensive patients.Methods: The design of this research is pre-experimental with cross sectional study approach. The population in this study were all patients with hypertension who took part in management program activities in the public health center (PHC), a number of 40 people, with the sampling technique used was accidental sampling and the total sample was 28 people. The data collection method used a questionnaire. The data analysis of this research is to use the Paired t test.Results: The result of this study is that there is a relationship between the application of a chronis disease management programs based on caring theory with blood pressure reduction with an average systolic blood pressure before the intervention of 142?26.15 and after the intervention of 138?1.21 with p= 0.000 which means that the module intervention can decrease systolic and diastolic blood pressure. While for diastolic blood pressure, the results of the study showed that the mean blood pressure before the intervention was 85?10.36 and after the intervention was 85?7.61 with p= 0.000.Conclusion: It can be concluded that there is a possitive effect between giving prolanis module based on caring theory with systolic and diastolic blood pressure

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

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.

Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data

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 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 cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods Based on data from a regional myocardial infarction registry and a 2-year 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 healths well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results Of 1094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65–1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72–1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in 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, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of additional confounding variables.

Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction. A longitudinal study based on registry data

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 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 cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: Based on data from a regional myocardial infarction registry and a 2-year 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 healthas well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results: Of 1,094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65-1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72-1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in 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, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of confounding variables.

Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction. A longitudinal study based on registry data

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 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 cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: Based on data from a regional myocardial infarction registry and a 2-year 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 healthas well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results: Of 1,094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65-1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72-1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in 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, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of confounding variables.

APPROACH TO DISEASE MANAGEMENT CONCEPTS AND CONTENT

Disease management is a holistic approach to care for patients in the residential community, integrating holistically and continuously to minimize preventable events by maximizing compliance of patients with health care and promotion behaviors according to regulations. These programs produce significant improvements in health, as well as financial savings. This article initially approaches the concept and main content of disease management and chronic disease management programs.

Gender differences in heart failure: results from disease-management-programs

Introduction Among cardiovascular conditions, heart failure shows the highest rate of mortality. Despite increased awareness, striking differences in prognosis between men and women with HF still exist in ambulatory health care. In Germany, disease-management-programs (DMP) recognized this need and launched a structured treatment program especially for HF. Indicators assessing successful prevention and quality of care within DMP include among others, referral and prescription rates of prognosis-relevant medications (beta-blockers, AC-I, AT-1-antagonists). Aim To evaluate gender differences in heart failure therapy in the State of North-Rhine Westfalia, Germany. Methods Cross sectional analysis of the 2018 cohort (n=84.398, mean age 79±10.2 yrs., male 61.5%). Logistic regression analyses were run on referrals and prescription of beta-blockers, ACE-I and AT-1-antagonists (all, yes/no). Models tested for gender effects and included known covariates e.g. age and duration of participation (in yrs.) and comorbidities (diabetes, lipid disorder, hypertension, smoking, all yes/no). Results Logistic regression models indicated that gender significantly affected referral rates, OR 1.15, CI-95% 1.09–1.20 and OR 1.15, CI-95% 1.09–1.20, for referrals to hospitals and other physicians. Men received higher rates of referrals to other physicians and other institutions (26.5 vs. 14.2%) and (6.4 vs. 3.5%) than women. Prescription rates were also significantly associated with gender: OR 1.23, CI-95% 1.19–1.27, OR 1.36, CI-95% 1.29–1.43, and OR 0.79, CI-95% 0.72–0.87, for beta-blockers, ACE-I and AT-1-antagonists, respectively. Men received beta-blocker and ACE-I more often (33.8 vs. 4.4% and 28.6 and 8.1%); women had higher rates of AT-1- antagonist prescription (1.2 vs. 5.5%). Conclusion Although, as previously shown work indicated, differences decrease over time, marked gender differences in referral and prescription rates in heart failure still exist in ambulatory health care settings. These results indicate that secondary prevention in women with HF needs to improve. Funding Acknowledgement Type of funding source: None