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Höglinger M, Wirth B, Carlander M, Caviglia C, Frei C, Rhomberg B, Rohrbasser A, Trottmann M, Eichler K. Impact of a diabetes disease management program on guideline-adherent care, hospitalization risk and health care costs: a propensity score matching study using real-world data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:469-478. [PMID: 35716315 PMCID: PMC10060321 DOI: 10.1007/s10198-022-01486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the impact of a DMP for patients with diabetes mellitus in a Swiss primary care setting. METHODS In a prospective observational study, we compared diabetes patients in a DMP (intervention group; N = 538) with diabetes patients receiving usual care (control group; N = 5050) using propensity score matching with entropy balancing. Using a difference-in-difference (DiD) approach, we compared changes in outcomes from baseline (2017) to 1-year (2017/18) and to 2-year follow-up (2017/19). Outcomes included four measures for guideline-adherent diabetes care, hospitalization risk, and health care costs. RESULTS We identified a positive impact of the DMP on the share of patients fulfilling all measures for guideline-adherent care [DiD 2017/18: 7.2 percentage-points, p < 0.01; 2017/19: 8.4 percentage-points, p < 0.001]. The hospitalization risk was lower in the intervention group in both years, but only statistically significant in the 1-year follow-up [DiD 2017/18: - 5.7 percentage-points, p < 0.05; 2017/19: - 3.9 percentage points, n.s.]. The increase in health care costs was smaller in the intervention than in the control group [DiD 2017/18: CHF - 852; 2017/19: CHF - 909], but this effect was not statistically significant. CONCLUSION The DMP under evaluation seems to exert a positive impact on the quality of diabetes care, reflected in the increase in the measures for guideline-adherent care and in a reduction of the hospitalization risk in the intervention group. It also might reduce health care costs, but only a longer follow-up will show whether the observed effect persists over time.
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Affiliation(s)
- Marc Höglinger
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland.
| | - Brigitte Wirth
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland
| | - Maria Carlander
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland
| | | | | | | | - Adrian Rohrbasser
- Medbase Health Care Provider, Winterthur, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Klaus Eichler
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland
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Safieddine B, Trachte F, Sperlich S, Epping J, Lange K, Geyer S. Trends of Antidiabetic and Cardiovascular Diseases Medication Prescriptions in Type 2 Diabetes between 2005 and 2017-A German Longitudinal Study Based on Claims Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4491. [PMID: 36901500 PMCID: PMC10001865 DOI: 10.3390/ijerph20054491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND With an attempt to understand possible mechanisms behind the severity-dependent development of type 2 diabetes (T2D) comorbidities, this study examines the trends of antidiabetic and cardiovascular diseases (CVD) medication prescriptions in individuals with T2D. METHODS The study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. The period prevalence of antidiabetic and CVD medication prescriptions was examined for the periods 2005-2007, 2010-2012, and 2015-2017 in 240,241, 295,868, and 308,134 individuals with T2D, respectively. (Ordered) logistic regression analyses were applied to examine the effect of time period on the number and prevalence of prescribed medications. Analyses were stratified by gender and three age groups. RESULTS The number of prescribed medications per person has increased significantly for all examined subgroups. For the two younger age groups, insulin prescriptions decreased but those of non-insulin medications increased, while both increased significantly over time for the age group of 65+ years. Except for glycosides and antiarrhythmic medications, the predicted probabilities for CVD medications increased over the examined periods, with lipid-lowering agents demonstrating the highest increase. CONCLUSIONS Results point towards an increase in medication prescriptions in T2D, which is in line with the evidence of the increase in most comorbidities indicating morbidity expansion. The increase in CVD medication prescriptions, especially lipid-lowering agents, could explain the specific development of severe and less severe T2D comorbidities observed in this population.
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Affiliation(s)
- Batoul Safieddine
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Florian Trachte
- Accident and Emergency Department, St. Vincenz Hospital, Am Busdorf 2, 33098 Paderborn, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Roth M, Lehmann T, Kloos C, Schmidt S, Kellner C, Wolf G, Müller N. Metabolic Control, Diabetic Complications and Drug Therapy in a Cohort of Patients with Type 1 and Type 2 Diabetes in Secondary and Tertiary Care between 2004 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2631. [PMID: 36768000 PMCID: PMC9916122 DOI: 10.3390/ijerph20032631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. METHODS Retrospective cross-sectional analysis of four single-centre cohorts between 2004 and 2019. All patients with T1DM or T2DM in secondary care (n = 5571) or tertiary care (n = 2001) were included. Statistical analyses were performed using linear mixed models. RESULTS Diabetes duration increased in both patients with T1DM and T2DM in secondary care and tertiary care (p < 0.001). Patients in secondary care consistently showed good glycaemic control, while patients in tertiary care showed inadequate glycaemic control. All four cross-sectional cohorts showed a significant increase in the prevalence of nephropathy over time and three out of four cohorts (T1DM and T2DM in secondary care and T2DM in tertiary care) showed an increase in the prevalence of neuropathy (all p < 0.001). The incidence of severe hypoglycaemia was consistently low. The use of insulin pumps and insulin analogues in the therapy of T1DM increased significantly. CONCLUSIONS The increased prevalence of complications is likely due to older age and longer diabetes duration. Low rates of hypoglycaemia, lower limb amputations and good glycaemic control in secondary care patients indicate a good structure of patient care.
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Affiliation(s)
- Matthias Roth
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, 07743 Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Sebastian Schmidt
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Christiane Kellner
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Nicolle Müller
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
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Strumann C, Blickle PG, von Meißner WCG, Steinhäuser J. The use of routine data from primary care practices in Germany to analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus. BMC PRIMARY CARE 2022; 23:327. [PMID: 36522736 PMCID: PMC9754999 DOI: 10.1186/s12875-022-01945-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Routinely collected health data from ambulatory care providers offer a wide range of research opportunities. However, the access is often (e.g., technically) hindered, particularly in Germany. In the following, we describe the development of an infrastructure for the analysis of pseudonymized routine data extracted from primary care practices in Germany. Further, we analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus (DM type 2). METHODS In this retrospective cohort study, routine data were extracted from nine private primary care practices before and since the outbreak of SARS-CoV-2 in Germany. The sample consisted of patients who were treated between 2016 and 2022 in one of the participating practices. The effects of the outbreak on the frequency of practice visits and the disease course of DM type 2 patients were analyzed by means of bivariate and multivariate analyses. RESULTS The developed infrastructure offers an analysis of routine data from outpatient care within 24 h. In total, routine data of 30,734 patients could be processed for the analyses with 4182 (13.6%) patients having a diagnosed DM type 2 and 59.0% of these patients were enrolled in a disease management program (DMP). In the multivariate analysis, there was a significant negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease. This decrease was less pronounced among DMP patients. The glycated haemoglobin level (HbA1c) has not changed significantly. CONCLUSIONS The study showed that the analysis of routine data from outpatient care in Germany is possible in a timely manner using a special developed electronic health record system and corresponding software. The significantly negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease was less pronounced among DMP patients. Two years after the start of the Covid pandemic a significantly worsened course of illness cannot be observed. However, it must be taken into account that the observation period for clinically relevant outcomes is still relatively short.
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Affiliation(s)
- Christoph Strumann
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Paul-Georg Blickle
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany ,Hausärzte am Spritzenhaus, Family Practice, Baiersbronn, Germany
| | - Wolfgang C. G. von Meißner
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany ,Hausärzte am Spritzenhaus, Family Practice, Baiersbronn, Germany
| | - Jost Steinhäuser
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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Kauhl B, Vietzke M, König J, Schönfelder M. Exploring regional and sociodemographic disparities associated with unenrollment for the disease management program for type 2 Diabetes Mellitus using Bayesian spatial modelling. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:7. [PMID: 39177711 PMCID: PMC11281746 DOI: 10.1007/s43999-022-00007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/21/2022] [Indexed: 08/24/2024]
Abstract
BACKGROUND The disease management program (DMP) for type 2 Diabetes Mellitus (T2DM) is the largest DMP in Germany. Our goal was to analyze regional differences in unenrollment rates, suggest areas for intervention and provide background information, which population groups in which locations are currently not enrolled in the DMP for T2DM. METHODS In this study, we used data of the 1.7 mil. insurants of the AOK Nordost health insurance. For the visualization of enrollment potential, we used the Besag-York-Mollie model (BYM). The spatial scan statistic (SaTScan) was used to detect areas of unusually high rates of unenrolled diabetics to prioritize areas for intervention. To explore sociodemographic associations, we used Bayesian spatial global regression models. A Spatially varying coefficient model (SVC) revealed in how far the detected associations vary over space. RESULTS The proportion of diabetics currently not enrolled in the DMP T2DM was 36.8% in 2019 and varied within northeastern Germany. Local clusters were detected mainly in Mecklenburg-West-Pomerania and Berlin. The main sociodemographic variables associated with unenrollment were female sex, younger age, being unemployed, foreign citizenship, small household size and the proportion of persons commuting to work outside their residential municipality. The SVC model revealed important spatially varying effects for some but not all associations. CONCLUSION Lower socioeconomic status and foreign citizenship had an ubiquitous effect on not being enrolled. The DMP T2DM therefore does currently not reach those population groups, which have a higher risk for secondary diseases and possible avoidable hospitalizations. Logically, future interventions should focus on these groups. Our methodology clearly suggests areas for intervention and points out, which population group in which locations should be specifically approached.
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Affiliation(s)
- B Kauhl
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany.
| | - M Vietzke
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - J König
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - M Schönfelder
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
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Brunn M. Born in the USA? A Comparison of "Inspired" Health Care Reforms in Germany and France. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:27-61. [PMID: 34280255 DOI: 10.1215/03616878-9417442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CONTEXT Despite numerous examples of health policy transfer in Western health systems, the nature of such "inspired" reforms has received little detailed attention. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms using the theoretical frameworks of transfer and translation. METHODS The design is based on a comparative case study: the introduction of disease management programs (DMPs) for diabetes in Germany in 2002 and in France in 2008, drawing on a literature review and semistructured interviews. FINDINGS In introducing its DMP, Germany chose and combined several components in a process of selective borrowing, while France opted for copying a specific foreign program and adapting it. Such differences in process are linked to distinct system structures, in particular the setup of health insurance and the representation of physicians. Furthermore, the displayed versus actual degree of inspiration varied significantly, with a branding strategy in Germany (high display of foreign influence) and the inverse picture in France (high degree of actual inspiration). CONCLUSIONS This analysis has applied the dual perspective of transfer and translation. Both perspectives proved complementary and necessary, and translation appeared as a main determinant of implementation success.
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Lazarus JV, Mark HE, Anstee QM, Arab JP, Batterham RL, Castera L, Cortez-Pinto H, Crespo J, Cusi K, Dirac MA, Francque S, George J, Hagström H, Huang TTK, Ismail MH, Kautz A, Sarin SK, Loomba R, Miller V, Newsome PN, Ninburg M, Ocama P, Ratziu V, Rinella M, Romero D, Romero-Gómez M, Schattenberg JM, Tsochatzis EA, Valenti L, Wong VWS, Yilmaz Y, Younossi ZM, Zelber-Sagi S. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol 2022; 19:60-78. [PMID: 34707258 DOI: 10.1038/s41575-021-00523-4] [Citation(s) in RCA: 341] [Impact Index Per Article: 170.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. .,EASL International Liver Foundation, Geneva, Switzerland.
| | - Henry E Mark
- EASL International Liver Foundation, Geneva, Switzerland
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rachel L Batterham
- Centre for Obesity Research, University College London and National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Université de Paris, Paris, France
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Javier Crespo
- Gastroenterology and Heptology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Santander, Spain
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Veterans Health Administration and University of Florida, Gainesville, FL, USA
| | - M Ashworth Dirac
- Department of Health Metrics Sciences, Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sven Francque
- Department of Gastroenterology Hepatology, University Hospital Antwerp, Antwerp, Belgium.,Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Hannes Hagström
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Terry T-K Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rohit Loomba
- Department of Medicine, NAFLD Research Center, La Jolla, CA, USA.,Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Veronica Miller
- University of California Berkeley, School of Public Health, Forum for Collaborative Research, Washington, DC, USA
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | | | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vlad Ratziu
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitie-Salpetriere, University of Paris, Paris, France
| | - Mary Rinella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Diana Romero
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Manuel Romero-Gómez
- UCM Digestive Diseases, CIBEREHD and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Emmanuel A Tsochatzis
- University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.,Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Precision Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yusuf Yilmaz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.,Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | | | - Shira Zelber-Sagi
- University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel.,Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel
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8
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Effectiveness of the German disease management programs: quasi-experimental analyses assessing the population-level health impact. BMC Public Health 2021; 21:2092. [PMID: 34781907 PMCID: PMC8591814 DOI: 10.1186/s12889-021-12050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12050-7.
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Lazarus JV, Anstee QM, Hagström H, Cusi K, Cortez-Pinto H, Mark HE, Roden M, Tsochatzis EA, Wong VWS, Younossi ZM, Zelber-Sagi S, Romero-Gómez M, Schattenberg JM. Defining comprehensive models of care for NAFLD. Nat Rev Gastroenterol Hepatol 2021; 18:717-729. [PMID: 34172937 DOI: 10.1038/s41575-021-00477-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is now the leading cause of chronic liver disease globally. Despite the increased demand placed on health-care systems, little attention has been given to the design and implementation of efficient and effective models of care for patients with NAFLD. In many health-care settings, no formal pathways exist and, where pathways are in place, they are often not standardized according to good practices. We systematically searched the peer-reviewed literature with the aim of identifying published examples of comprehensive models of care that answered four key questions: what services are provided? Where are they provided? Who is offering them? How are they coordinated and integrated within health-care systems? We identified seven models of care and synthesized the findings into eight recommendations nested within the 'what, where, who and how' of care models. These recommendations, aimed at policy-makers and practitioners designing and implementing models of care, can help to address the increasing need for the provision of good practice care for patients with NAFLD.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. .,EASL International Liver Foundation, Geneva, Switzerland.
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Liver Unit & NIHR Biomedical Research Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Kenneth Cusi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Veterans Health Administration and University of Florida, Gainesville, FL, United States
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Henry E Mark
- EASL International Liver Foundation, Geneva, Switzerland
| | - Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany.,Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany
| | - Emmanuel A Tsochatzis
- University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.,Sheila Sherlock Liver Centre, Royal Free Hospital, London, United Kingdom
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Shira Zelber-Sagi
- University of Haifa, Faculty of Social Welfare and Health Sciences, School of Public Health, Mount Carmel, Haifa, Israel.,Department of Gastroenterology, Tel-Aviv Medical Centre, Tel-Aviv, Israel
| | - Manuel Romero-Gómez
- UCM Digestive Diseases, CIBEREHD and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain.
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany.
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10
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Wangler J, Jansky M. Attitudes to and experience of disease management programs in primary care-an exploratory survey of general practitioners in Germany. Wien Med Wochenschr 2021; 171:310-320. [PMID: 34338907 PMCID: PMC8484225 DOI: 10.1007/s10354-021-00867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
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. Supplementary Information The online version of this article (10.1007/s10354-021-00867-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julian Wangler
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Am Pulverturm 13, 55131 Mainz, Germany
| | - Michael Jansky
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Am Pulverturm 13, 55131 Mainz, Germany
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11
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Wintergerst MWM, Bejan V, Hartmann V, Schnorrenberg M, Bleckwenn M, Weckbecker K, Finger RP. Telemedical Diabetic Retinopathy Screening in a Primary Care Setting: Quality of Retinal Photographs and Accuracy of Automated Image Analysis. Ophthalmic Epidemiol 2021; 29:286-295. [PMID: 34151725 DOI: 10.1080/09286586.2021.1939886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Screening for diabetic eye disease (DED) and general diabetes care is often separate, which leads to delays and low adherence to DED screening recommendations. Thus, we assessed the feasibility, achieved image quality, and possible barriers of telemedical DED screening in a point-of-care general practice setting and the accuracy of an automated algorithm for detection of DED.Methods: Patients with diabetes were recruited at general practices. Retinal images were acquired using a non-mydriatic camera (CenterVue, Italy) by medical assistants. Images were quality assessed and double graded by two graders. All images were also graded automatically using a commercially available artificial intelligence (AI) algorithm (EyeArt version 2.1.0, Eyenuk Inc.).Results: A total of 75 patients (147 eyes; mean age 69 years, 96% type 2 diabetes) were included. Most of the patients (51; 68%) preferred DED screening at the general practice, but only twenty-four (32%) were willing to pay for this service. Images of 63 patients (84%) were determined to be evaluable, and DED was diagnosed in 6 patients (8.0%). The algorithm's positive/negative predictive values (95% confidence interval) were 0.80 (0.28-0.99)/1.00 (0.92-1.00) and 0.75 (0.19-0.99)/0.98 (0.88-1.00) for detection of any DED and referral-warranted DED, respectively.Overall, the number of referrals was 18 (24%) for manual telemedical assessment and 31 (41%) for the artificial intelligence (AI) algorithm, resulting in a relative increase of referrals by 72% when using AI.Conclusions: Our study shows that achieved overall image quality in a telemedical GP-based DED screening was sufficient and that it would be accepted by medical assistants and patients in most cases. However, good image quality and integration into existing workflow remain challenging. Based on these findings, a larger-scale implementation study is warranted.
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Affiliation(s)
| | - Veronica Bejan
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Vera Hartmann
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Marina Schnorrenberg
- Institute of General Practice and Interprofessional Care, Faculty of Health/Department of Medicine, University Witten/Herdecke, Witten, Germany
| | - Markus Bleckwenn
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Interprofessional Care, Faculty of Health/Department of Medicine, University Witten/Herdecke, Witten, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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12
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Pohontsch NJ, Schulze J, Hoeflich C, Glassen K, Breckner A, Szecsenyi J, Lühmann D, Scherer M. Quality of care for people with multimorbidity: a focus group study with patients and their relatives. BMJ Open 2021; 11:e047025. [PMID: 34130962 PMCID: PMC8208013 DOI: 10.1136/bmjopen-2020-047025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Prevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients' perspective and match them to a literature-based set of QIs. METHODS We conducted eight focus groups with patients with multimorbidity and three focus groups with patients' relatives using a semistructured guide. Data were analysed using Kuckartz's qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI. RESULTS We created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants' accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups. CONCLUSION We show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity. TRIAL REGISTRATION NUMBER German clinical trials registry (DRKS00015718), Pre-Results.
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Affiliation(s)
- Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Charlotte Hoeflich
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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Baumert J, Paprott R, Du Y, Heidemann C, Scheidt-Nave C. Self-assessed quality of care among adults with diagnosed diabetes in Germany. JOURNAL OF HEALTH MONITORING 2021; 6:36-42. [PMID: 35146308 PMCID: PMC8734079 DOI: 10.25646/8329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
People who have diabetes require regular medical care. The views of patients about the quality of their care are becoming increasingly relevant when it comes to chronic diseases such as diabetes. As part of the nationwide study Disease Knowledge and Information Needs - Diabetes mellitus (2017), data on self-assessed quality of care by people with diagnosed diabetes was collected using the Patient Assessment of Chronic Illness Care - DAWN short form (PACIC-DSF, scale 1 to 5) and analysed for respondents aged 45 years or above. The average score for quality of care was 2.47 and was lower for women than for men (2.33 vs 2.58). The respondents assessed the quality of their care as being worse with rising age and size of the population in their residential area. No significant differences were observed by education group. Overall, people with diabetes in Germany consider the quality of their care to be moderate, which indicates a need for improvement in care.
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Affiliation(s)
- Jens Baumert
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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14
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Valentijn PP, Kerkhoven M, Heideman J, Arends R. Cross-sectional study evaluating the association between integrated care and health-related quality of life (HRQOL) in Dutch primary care. BMJ Open 2021; 11:e040781. [PMID: 33811050 PMCID: PMC8023735 DOI: 10.1136/bmjopen-2020-040781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the association between integrated care and health-related quality of life (HRQOL) in a primary care practice population. DESIGN A cross-sectional survey study. SETTING Primary care practice population. PARTICIPANTS A sample (n=5562) of patients in two general practitioner practices in the Netherlands. PRIMARY OUTCOME MEASURES The Rainbow Model of Integrated Care Measurement Tool patient version and EQ-5D was used to assess integrated service delivery and HRQOL. The association between integrated care and HRQOL groups was analysed using multivariate logistic regression. RESULTS Overall, 933 respondents with a mean age of 62 participated (20% response rate) in this study. The multivariate analysis revealed that positive organisational coordination experiences were linked to better HRQOL (OR=1.87, 95% CI 1.18 to 2.95), and less anxiety and depression problems (OR=0.36, 95% CI 0.20 to 0.63). Unemployment was associated with a poor HRQOL (OR=0.15, 95% CI 0.08 to 0.28). Ageing was associated with more mobility (OR=1.06, 95% CI 1.04 to 1.09), self-care (OR=1.06, 95% CI 1.02 to 1.11), usual activity (OR=1.03, 95% CI 1.01 to 1.05) and pain problems (OR=1.02, 95% CI 1.01 to 1.04). Being married improved the overall HRQOL (OR=1.60, 95% CI 1.13 to 2.26) and decreased anxiety and depression (OR=0.47, 95% CI 0.31 to 0.72). Finally, females had a poor overall HRQOL (OR=1.67, 95% CI 0.48 to 0.93) and more pain and discomfort problems (OR=1.47, 95% CI 1.11 to 1.95). CONCLUSION This study shows for the first time that organisational coordination activities are positively associated with HROQL of adult patients in a primary care context, adding to the evidence of an association between integrated care and HRQOL. Also, unemployment, ageing and being female are accumulating risk factors that should be considered when designing integrated primary care programmes. Further research is needed to explore how various integration types relate to HRQOL for people in local communities.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Integrated Care Evaluation, Essenburgh Research & Consultancy, Hierden, The Netherlands
| | | | | | - Rosa Arends
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
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15
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Sperlich S, Beller J, Epping J, Safieddine B, Tetzlaff J, Geyer S. Are Disability Rates among People with Diabetes Increasing in Germany? A Decomposition Analysis of Temporal Change between 2004 and 2015. J Aging Health 2021; 33:205-216. [PMID: 33135530 PMCID: PMC7917560 DOI: 10.1177/0898264320970324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: We investigated changes in the prevalence of disabilities among individuals with type 2 diabetes and analyzed the contribution of comorbidities on this change. Methods: Data were drawn from the Survey of Health, Ageing, and Retirement in Europe (SHARE). We estimated predicted probabilities of impaired (instrumental) activities of daily living (IADL and ADL) by means of logistic regression. Multivariate decomposition was employed for analyzing the impact of comorbidities on changes in disability rates. Results: Among people with diabetes, ADL difficulties rose significantly from 11.3% (2004) to 19.1% (2015), while IADL difficulties increased among younger diabetics from 11.5% to 18.3%. Decomposition analysis revealed that the parallel increase in comorbidities contributed to the rise in disabilities. Discussion: We found disability rates among people with diabetes in Germany to be increasing over time, pointing toward a growing demand of tertiary prevention for these individuals to maintain functional health and quality of life.
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Affiliation(s)
| | - Johannes Beller
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Jelena Epping
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | | | | | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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16
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Fischer C, Höpner J, Hartwig S, Noutsias M, Mikolajczyk R. Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data. BMC Cardiovasc Disord 2021; 21:18. [PMID: 33407174 PMCID: PMC7788767 DOI: 10.1186/s12872-020-01832-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
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 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.
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Affiliation(s)
- Christian Fischer
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Jens Höpner
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Saskia Hartwig
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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Geber C, Kappis B, Bäsch T, Casser HR. [Pain prevention in the primary care setting : Facts for resident physicians]. Schmerz 2021; 35:5-13. [PMID: 33404794 DOI: 10.1007/s00482-020-00521-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Based on health insurance data, approximately 37.4 million patients (46%) in Germany are diagnosed with "pain". The prevalence of patients with debilitating chronic pain is around 7.3%. From the health care perspective, and given the high socioeconomic relevance of chronic pain, effective preventive measures represent useful therapeutic approaches. In the context of pain medicine, primary prevention aims to avoid acute pain. Secondary prevention is targeted at preventing acute pain from turning into chronic pain. Tertiary prevention comprises measures to diminish pain-associated disability and impairment to everyday life. Finally, quaternary prevention focuses on avoiding medically non-indicated or unhelpful medical interventions. In addition to general approaches of pain prevention, such as detecting and treating of chronification factors (yellow, black and blue flags), the present article also describes educational and disease-specific approaches in musculoskeletal and neuropathic pain syndromes as well as headaches.
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Affiliation(s)
- C Geber
- DRK-Schmerz-Zentrum, Auf der Steig 14-16, 55131, Mainz, Deutschland.
| | - B Kappis
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - T Bäsch
- PhysioMed am DRK Schmerz-Zentrum Mainz GmbH, Auf der Steig 16, 55131, Mainz, Deutschland
| | - H R Casser
- DRK-Schmerz-Zentrum, Auf der Steig 14-16, 55131, Mainz, Deutschland
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Griebenow R, Mills P, Stein J, Herrmann H, Kelm M, Campbell C, Schäfer R. Outcomes in CME/CPD - Special Collection: How to make the "pyramid" a perpetuum mobile. J Eur CME 2020; 9:1832750. [PMID: 33194316 PMCID: PMC7599014 DOI: 10.1080/21614083.2020.1832750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Continuing medical education (CME) should not be an end in itself, but as expressed in Moore's pyramid, help to improve both individual patient and ultimately community, health. However, there are numerous barriers to translation of physician competence into improvements in community health. To enhance the effect CME may achieve in improving community health the authors suggest a kick-off/keep-on continuum of medical competence, and integration of aspects of public health at all levels from planning to delivery and outcomes measurement in CME.
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Affiliation(s)
| | - Peter Mills
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Jörg Stein
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Henrik Herrmann
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Malte Kelm
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Craig Campbell
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Robert Schäfer
- European Board for Accreditation in Cardiology (EBAC), Cologne, Germany
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Timpel P, Harst L, Reifegerste D, Weihrauch-Blüher S, Schwarz PEH. What should governments be doing to prevent diabetes throughout the life course? Diabetologia 2019; 62:1842-1853. [PMID: 31451873 DOI: 10.1007/s00125-019-4941-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022]
Abstract
Health systems and governments are increasingly required to implement measures that target at-risk populations to prevent noncommunicable diseases. In this review we lay out what governments should be doing to prevent diabetes throughout the life course. The following four target groups were used to structure the specific recommendations: (1) pregnant women and young families, (2) children and adolescents, (3) working age population, and (4) the elderly. The evidence to date supports the effectiveness of some known government policy measures, such as sugar taxes and regulatory measures in the (pre-)school setting for children and adolescents. Many of these appear to be more effective if they are part of a bundle of strategies and if they are supplemented by communication strategies. Although there is a current focus on strategies that target the individual, governments can make use of evidence-based population-level prevention strategies. More research and continuous evaluation of the overall and subgroup-specific effectiveness of policy strategies using high-quality longitudinal studies are needed.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Doreen Reifegerste
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Susann Weihrauch-Blüher
- Department of Pediatrics I, Pediatric Endocrinology and Diabetology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
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Ose D, Kamradt M, Kiel M, Freund T, Besier W, Mayer M, Krisam J, Wensing M, Salize HJ, Szecsenyi J. Care management intervention to strengthen self-care of multimorbid patients with type 2 diabetes in a German primary care network: A randomized controlled trial. PLoS One 2019; 14:e0214056. [PMID: 31188825 PMCID: PMC6561631 DOI: 10.1371/journal.pone.0214056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/22/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose This study aimed to assess the effectiveness of a care management intervention in improving self-management behavior in multimorbid patients with type 2 diabetes; care was delivered by medical assistants in the context of a primary care network (PCN) in Germany. Methods This study is an 18-month, multi-center, two-armed, open-label, patient-randomized parallel-group superiority trial (ISRCTN 83908315). The intervention group received the care management intervention in addition to the usual care. The control group received usual care only. The primary outcome was the change in self-care behavior at month 9 compared to baseline. The self-care behavior was measured with the German version of the Summary of Diabetes Self-Care Activities Measure (SDSCA-G). A multilevel regression analysis was applied. Results We assigned 495 patients to intervention (n = 252) and control (n = 243). At baseline, the mean age was 68 ±11 years, 47.8% of the patients were female and the mean HbA1c was 7.1±1.2%. The primary analysis showed no statistically significant effect, but a positive trend was observed (p = 0.206; 95%-CI = -0.084; 0.384). The descriptive analysis revealed a significantly increased sum score of the SDSCA-G in the intervention group over time (P = 0.012) but not in the control group (p = 0.1973). Conclusion The sum score for self-care behavior markedly improved in the intervention group over time. However, the results of our primary analysis showed no statistically significant effect. Possible reasons are the high baseline performance in our sample and the low intervention fidelity. The implementation of this care management intervention in PCNs has the potential to improve self-care behavior of multimorbid patients with type 2 diabetes.
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Affiliation(s)
- Dominik Ose
- University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT, United States of America
- University Hospital Heidelberg; Department of General Practice and Health Services Research; Marsilius-Arkaden, Turm West, Heidelberg, Germany
- * E-mail:
| | - Martina Kamradt
- University Hospital Heidelberg; Department of General Practice and Health Services Research; Marsilius-Arkaden, Turm West, Heidelberg, Germany
| | - Marion Kiel
- University Hospital Heidelberg; Department of General Practice and Health Services Research; Marsilius-Arkaden, Turm West, Heidelberg, Germany
| | - Tobias Freund
- University Hospital Heidelberg; Department of General Practice and Health Services Research; Marsilius-Arkaden, Turm West, Heidelberg, Germany
| | - Werner Besier
- Genossenschaft Gesundheitsprojekt Mannheim e.G., Mannheim, Germany
| | - Manfred Mayer
- Genossenschaft Gesundheitsprojekt Mannheim e.G., Mannheim, Germany
| | - Johannes Krisam
- University Hospital Heidelberg, Institute of Medical Biometry and Informatics, Marsilius-Arkaden, Turm West, Heidelberg, Germany
| | - Michel Wensing
- University Hospital Heidelberg; Department of General Practice and Health Services Research; Marsilius-Arkaden, Turm West, Heidelberg, Germany
| | - Hans-Joachim Salize
- Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Joachim Szecsenyi
- University Hospital Heidelberg; Department of General Practice and Health Services Research; Marsilius-Arkaden, Turm West, Heidelberg, Germany
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Heidemann C, Du Y, Baumert J, Paprott R, Lampert T, Scheidt-Nave C. Social inequality and diabetes mellitus - developments over time among the adult population in Germany. JOURNAL OF HEALTH MONITORING 2019; 4:11-28. [PMID: 35146245 PMCID: PMC8822251 DOI: 10.25646/5986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/11/2019] [Indexed: 12/14/2022]
Abstract
The connection between social disadvantage and the presence of known diabetes and specific risk factors is well documented. This article summarises the results from the Robert Koch Institute examination surveys that were conducted between 1997 and 1999 as well as 2008 and 2011 to address social inequality - operationalised by level of education - with regard to prevalences of known and unknown diabetes, risk of diabetes and care of diabetes as well as their development over time. Both survey periods showed that the low education group has higher prevalences of known and unkown diabetes as well as a higher risk of developing diabetes within the next five years compared to the medium and high education group. Over time, prevalence tended to increase for known diabetes and to decrease for unknown diabetes for all education groups. For the 5-year diabetes risk, only the high education group showed a clear decrease over time. The chosen indicators of diabetes care indicated no clear differences between education groups and an improvement of diabetes care over time. For some indicators of care (foot examination, statins), improvements were only seen in the low education group. In conclusion, social inequalities in the prevalence of known and unknown diabetes as well as in diabetes risk remain in Germany; for the indicators of care, however, no clear education gradient is evident. Over time, inequality regarding the prevalence of diabetes has not increased further. However, with regard to diabetes risk, inequality has become slightly more evident. For individual care indicators, improvements are limited to specific education groups.
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Affiliation(s)
- Christin Heidemann
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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van Bruggen S, Rauh SP, Kasteleyn MJ, Bonten TN, Chavannes NH, Numans ME. Association between full monitoring of biomedical and lifestyle target indicators and HbA 1c level in primary type 2 diabetes care: an observational cohort study (ELZHA-cohort 1). BMJ Open 2019; 9:e027208. [PMID: 30867205 PMCID: PMC6429872 DOI: 10.1136/bmjopen-2018-027208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Management of type 2 diabetes mellitus (T2DM) requires frequent monitoring of patients. Within a collective care group setting, doubts on the clinical effects of registration are a barrier for full adoption of T2DM registration in general practice. We explored whether full monitoring of biomedical and lifestyle-related target indicators within a care group approach is associated with lower HbA1c levels. DESIGN Observational, real-life cohort study. SETTING Primary care data registry from the Hadoks (EerstelijnsZorggroepHaaglanden) care group. EXPOSURE The care group provides general practitioners collectively with organisational support to facilitate structured T2DM primary care. Patients are offered quarterly medical and lifestyle-related consultation. MAIN OUTCOME MEASURE Full monitoring of each target indicator in patients with T2DM which includes minimally one measure of HbA1c level, systolic blood pressure, LDL, BMI, smoking behaviour and physical exercise between January and December 2014; otherwise, patients were defined as 'incompletely monitored'. HbA1c levels of 8137 fully monitored and 3958 incompletely monitored patients were compared, adjusted for the confounders diabetes duration, age and gender. Since recommended HbA1c values depend on age, medication use and diabetes duration, analyses were stratified into three HbA1c profile groups. Linear multilevel analyses enabled adjustment for general practice. RESULTS Compared with incompletely monitored patients, fully monitored patients had significantly lower HbA1c levels (95% CI) in the first (-2.03 [-2.53 to -1.52] mmol/mol) (-0.19% [-0.23% to -0.14%]), second (-3.36 [-5.28 to -1.43] mmol/mol) (-0.31% [-0.48% to -0.13%]) and third HbA1c profile group (-1.89 [-3.76 to -0.01] mmol/mol) (-0.17% [-0.34% to 0.00%]). CONCLUSIONS/INTERPRETATION This study shows that in a care group setting, fully monitored patients had significantly lower HbA1c levels compared with incompletely monitored patients. Since this difference might have considerable clinical impact in terms of T2DM-related risks, this might help general practices in care group settings to overcome barriers on adequate registration and thus improve structured T2DM primary care. From population health management perspective, we recommend a systematic approach to adjust the structured care protocol for incompletely monitored subgroups.
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Affiliation(s)
- Sytske van Bruggen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- HADOKS (ELZHA), The Hague, The Netherlands
| | - Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marise J Kasteleyn
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Tobias N Bonten
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Pedron S, Emmert-Fees K, Laxy M, Schwettmann L. The impact of diabetes on labour market participation: a systematic review of results and methods. BMC Public Health 2019; 19:25. [PMID: 30616606 PMCID: PMC6323654 DOI: 10.1186/s12889-018-6324-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 12/14/2018] [Indexed: 05/04/2023] Open
Abstract
Background Diabetes mellitus is a major chronic disease, which is connected to direct and indirect costs and productivity losses. However, its effects on labour market participation are not straightforward to identify, nor are they consistently included in cost-of-illness studies. First, this study aims to synthesise existing evidence regarding the impact of diabetes on labour market outcomes that imply a complete absence of work. Second, the analysis takes a particular look at relevant methodological choices and the resulting quality of the studies included. Methods We conducted a systematic literature research (PubMed, Embase, PsychINFO), by applying a standard screening, selection and results extraction process, which considered all types of studies including cross-sectional and longitudinal approaches. Risk-of-bias and quality within the studies were assessed and results were compared. We dedicated special attention to the modelling of potential reverse causality between diabetes and labour market outcomes and the consideration of comorbidities and complications. Results Overall, 30 studies satisfied our inclusion criteria. We identified four main labour participation outcomes: absence of employment, unemployment, early retirement, and disability pension. The studies reviewed show a negative impact of diabetes on the labour market participation outcomes considered. However, only a few studies controlled for endogeneity, differentiated between type 1 and type 2 diabetes or modelled the impact of comorbidities. We report how modelling choices affect the directions and interpretations of the effects. Conclusions The available evidence mainly suggests a negative impact of diabetes on several outcomes indicating labour market participation. The methodological limitations identified can guide future research with respect to both outcomes and methods. This study provides therefore an empirical contribution to the discussion on how to model the economic impact of diabetes. Electronic supplementary material The online version of this article (10.1186/s12889-018-6324-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Pedron
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. .,German Center for Diabetes Research (DZD), Neuherberg, Germany.
| | - Karl Emmert-Fees
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Michael Laxy
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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Buhse S, Kuniss N, Liethmann K, Müller UA, Lehmann T, Mühlhauser I. Informed shared decision-making programme for patients with type 2 diabetes in primary care: cluster randomised controlled trial. BMJ Open 2018; 8:e024004. [PMID: 30552272 PMCID: PMC6303685 DOI: 10.1136/bmjopen-2018-024004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To translate an informed shared decision-making programme (ISDM-P) for patients with type 2 diabetes from a specialised diabetes centre to the primary care setting. DESIGN Patient-blinded, two-arm multicentre, cluster randomised controlled trial of 6 months follow-up; concealed randomisation of practices after patient recruitment and acquisition of baseline data. SETTING 22 general practices providing care according to the German Disease Management Programme (DMP) for type 2 diabetes. PARTICIPANTS 279 of 363 eligible patients without myocardial infarction or stroke. INTERVENTIONS The ISDM-P comprises a patient decision aid, a corresponding group teaching session provided by medical assistants and a structured patient-physician encounter.Control group received standard DMP care. PRIMARY AND SECONDARY OUTCOME MEASURES Primary endpoint was patient adherence to antihypertensive or statin drug therapy by comparing prescriptions and patient-reported uptake after 6 months. Secondary endpoints included informed choice, risk knowledge (score 0-11 from 11 questions) and prioritised treatment goals of patients and doctors. RESULTS ISDM-P: 11 practices with 151 patients; standard care: 11 practices with 128 patients; attrition rate: 3.9%. There was no difference between groups regarding the primary endpoint. Mean drug adherence rates were high for both groups (80% for antihypertensive and 91% for statin treatment). More ISDM-P patients made informed choices regarding statin intake, 34% vs 3%, OR 16.6 (95% CI 4.4 to 63.0), blood pressure control, 39% vs 3%, OR 22.2 (95% CI 5.3 to 93.3) and glycated haemoglobin, 43% vs 3%, OR 26.0 (95% CI 6.5 to 104.8). ISDM-P patients achieved higher levels of risk knowledge, with a mean score of 6.96 vs 2.86, difference 4.06 (95% CI 2.96 to 5.17). In the ISDM-P group, agreement on prioritised treatment goals between patients and doctors was higher, with 88.5% vs 57%. CONCLUSIONS The ISDM-P was successfully implemented in general practices. Adherence to medication was very high making improvements hardly detectable. TRIAL REGISTRATION NUMBER ISRCTN77300204; Results.
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Affiliation(s)
- Susanne Buhse
- Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | - Nadine Kuniss
- Department of Internal Medicine III, Endocrinology and Metabolic Diseases, Jena University Hospital, Jena, Germany
- Diabetes Centre Thuringia, Jena, Germany
| | - Kathrin Liethmann
- Health Sciences and Education, University of Hamburg, Hamburg, Germany
- Institute of Medical Psychology and Sociology, University Medical Center Schleswig Holstein, Kiel, Germany
| | - Ulrich Alfons Müller
- Department of Internal Medicine III, Endocrinology and Metabolic Diseases, Jena University Hospital, Jena, Germany
- Diabetes Centre Thuringia, Jena, Germany
| | - Thomas Lehmann
- Centre for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Ingrid Mühlhauser
- Health Sciences and Education, University of Hamburg, Hamburg, Germany
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Koolen EH, van der Wees PJ, Westert GP, Dekhuijzen R, Heijdra YF, van 't Hul AJ. The COPDnet integrated care model. Int J Chron Obstruct Pulmon Dis 2018; 13:2225-2235. [PMID: 30050295 PMCID: PMC6056161 DOI: 10.2147/copd.s150820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction This research project sets out to design an integrated disease management model for patients with COPD who were referred to a secondary care setting and who qualified for pharmacological and nonpharmacological intervention options. Theory and methods The integrated disease management model was designed according to the guidelines of the European Pathway Association and the content founded on the Chronic Care Model, principles of integrated disease management, and knowledge of quality management systems. Results An integrated disease management model was created, and comprises 1) a diagnostic trajectory in a secondary care setting, 2) a nonmedical intervention program in a primary care setting, and 3) a pulmonary rehabilitation service in a tertiary care setting. The model also includes a quality management system and regional agreements about exacerbation management and palliative care. Discussion In the next phase of the project, the COPDnet model will be implemented in at least two different regions, in order to assess the added value of the entire model and its components, in terms of feasibility, health status benefits, and costs of care. Conclusion Based on scientific theories and models, a new integrated disease management model was developed for COPD patients, named COPDnet. Once the model is stable, it will be evaluated for its feasibility, health status benefits, and costs.
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Affiliation(s)
- Eleonore H Koolen
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gert P Westert
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,
| | - Yvonne F Heijdra
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,
| | - Alex J van 't Hul
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,
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Kreft D, McGuinness MB, Doblhammer G, Finger RP. Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 - A prospective cohort study based on health claims data. PLoS One 2018; 13:e0195426. [PMID: 29621309 PMCID: PMC5886553 DOI: 10.1371/journal.pone.0195426] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/26/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess factors associated with diabetic retinopathy (DR) screening uptake following a diagnosis of type 2 diabetes mellitus (type 2 diabetes) in Germany. MATERIALS AND METHODS A nationally representative prospective sample of individual-level health claims data for 250,000 members from Germany's largest public insurance provider in 2004-2013 was assessed. In the sample, 26,560 persons with incident type 2 diabetes were identified. Factors associated with subsequent DR screening were assessed using descriptive statistics, Kaplan-Meier estimator, and Cox regression analysis. RESULTS On average 27.6 visits to an ophthalmologist per 100 person-years in persons with incident type 2 diabetes occurred. Half of all incident cases (Kaplan-Meier estimator) had not seen an ophthalmologist after more than two years (2.25 years) following their diabetes diagnosis. In the multivariate analysis, an older age (from hazard ratio HR(70-74) = 0.93 [95%-CI: 0.89-0.97] to HR(90+) = 0.50 [95%-CI: 0.42-0.60] compared to persons aged 50-69 years) and a higher disability level (i.e. HR(disability level 3) = 0.30 [95%-CI: 0.25-0.36]) were associated with a lower likelihood, while female sex (HR = 1.12 [95%-CI: 1.08-1.15]), six or more comorbidities (HR = 1.26 [95%-CI: 1.15-1.37]), moderate (HR = 1.51 [95%-CI: 1.46-1.56]) or severe type 2 diabetes (HR = 1.53 [95%-CI: 1.45-1.61]) as well as being enrolled in a type 2 diabetes disease management program (HR = 1.78 [95%-CI: 1.69-1.87]) were associated with a higher likelihood of DR screening. CONCLUSIONS A high proportion of newly diagnosed persons with type 2 diabetes did not follow current German recommendations for DR screening, impeding timely detection and management of potential complications. This was more apparent among persons who were men, older or had a disability. The uptake of screening was considerably greater among those enrolled in a diseases management program. These factors need to be considered when planning DR screening services and/or referrals.
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Affiliation(s)
- Daniel Kreft
- Rostock Center for the Study of Demographic Change, Rostock, Germany
- Empirical Methods in Social Sciences and Demography, Institute for Sociology and Demography, University of Rostock, Rostock, Germany
| | - Myra B. McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Gabriele Doblhammer
- Rostock Center for the Study of Demographic Change, Rostock, Germany
- Empirical Methods in Social Sciences and Demography, Institute for Sociology and Demography, University of Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Robert P. Finger
- Ophthalmic Epidemiology, Department of Ophthalmology, University of Bonn, Bonn, Germany
- * E-mail:
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Röckl S, Brinks R, Baumert J, Paprott R, Du Y, Heidemann C, Scheidt-Nave C. All-cause mortality in adults with and without type 2 diabetes: findings from the national health monitoring in Germany. BMJ Open Diabetes Res Care 2017; 5:e000451. [PMID: 29435349 PMCID: PMC5759714 DOI: 10.1136/bmjdrc-2017-000451] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/05/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To estimate age-specific and sex-specific all-cause mortality among adults with and without type 2 diabetes (T2D) in Germany. RESEARCH DESIGN AND METHODS The German National Health Interview and Examination Survey 1998 (GNHIES98) included a mortality follow-up (median follow-up time 12.0 years) of its nationwide sample representative of the population aged 18-79 years. After exclusion of participants with type 1 diabetes, age- and sex-stratified mortality rates (MR) were calculated for 330 GNHIES98 participants with diagnosed T2D (self-reported diagnosis or antidiabetic medication), 245 with undiagnosed T2D (no diagnosed T2D, glycated hemoglobin A1c ≥6.5% (≥48 mmol/mol)), and 5975 without T2D. Mortality rate ratios (MRR) comparing MR of persons with and without T2D were estimated. Age-/sex-standardized MR and MRR were calculated including persons aged 45 years or older. MRR were used to estimate the number of years of life lost (YLL) due to diagnosed diabetes in 2010. RESULTS Over 75 994 person-years, 73 persons with undiagnosed T2D, 103 with diagnosed T2D, and 425 persons without T2D died. MRR were significantly higher in younger age groups, except for analyses limited to women or diagnosed T2D. Age- and sex-standardized MRR (95% CI) among persons aged 45 years or older were 1.96 (1.41 to 2.71) for undiagnosed, 1.68 (1.26 to 2.23) for diagnosed, and 1.82 (1.45 to 2.28) for total (undiagnosed or diagnosed) T2D. Sex-stratified analysis revealed similar age-standardized MRR for undiagnosed (1.56 (0.79 to 3.06)) and diagnosed T2D (1.56 (1.03 to 2.37)) among women, and a higher age-standardized MRR for undiagnosed (2.06 (1.43 to 2.97)) than diagnosed T2D (1.70 (1.10 to 2.63)) among men. YLL due to diagnosed diabetes in Germany in 2010 were 164 600 (35 000 to 279 300) among women and 169 900 (28 300 to 328 300) among men. CONCLUSIONS In Germany, age- and sex-standardized all-cause mortality is almost twice as high for adults with T2D as for adults without T2D. The T2D-associated excess risk of mortality appears to be most pronounced in younger adults and among men unaware of their T2D.
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Affiliation(s)
- Susanne Röckl
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ralph Brinks
- Institute of Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Heidemann C, Scheidt-Nave C. Prevalence, incidence and mortality of diabetes mellitus in adults in Germany - A review in the framework of the Diabetes Surveillance. JOURNAL OF HEALTH MONITORING 2017; 2:98-121. [PMID: 37168946 PMCID: PMC10165910 DOI: 10.17886/rki-gbe-2017-062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Continuous monitoring of the key epidemiological indicators of diabetes is necessary for evaluating the magnitude of diabetes as a public health problem, but is currently not being undertaken in Germany. A comprehensive literature review covering the last decades was conducted to give an overview of population-based studies reporting on diabetes prevalence, diabetes incidence, and diabetes-related mortality among adults in Germany. This review differentiates between known and unknown diabetes, but not between individual types of diabetes. Numerous studies have identified a considerable increase in the prevalence of known diabetes among the adult population over time. Until the 1960s, the prevalence of known diabetes remained below 1%. However, current nationwide estimates for Germany are much higher and range between 7.2% (population aged 18 to 79 years) based on health examination surveys of the Robert Koch Institute (RKI), 8.9% (population aged 18 years and over) based on RKI telephone health interview surveys and 9.9% (among all age groups) based on statutory health insurance data. Few available estimates point to an increase in the incidence of known diabetes since the 1960s. For example, a comparison of data from the diabetes register of the former German Democratic Republic (GDR) in 1960 with current follow-up data from RKI survey participants shows that incidence rates increased from 1.2 (all age groups) to 6.9 (population aged 18 to 79 years) per 1,000 person-years. Data on diabetes-related mortality are also scarce, but indicate that excess mortality persists among people with known diabetes compared to those in the same age group without the condition, despite the finding of decreasing mortality rates among people with known diabetes. For example, the mortality rate based on early data from the GDR diabetes register was 1.9-fold higher among people with known diabetes than among the general population; current mortality follow-up data of RKI survey participants show a 1.7-fold higher mortality rate among people with known diabetes compared to those without the condition. Given the limited data that are currently available and the considerable variation of diagnostic criteria, it is not possible to estimate time trends in the prevalence, incidence or mortality of unknown diabetes. An extension of available health monitoring approaches and an improved use of existing data sources for secondary analysis are needed for a reliable evaluation of dynamics in diabetes epidemiology in Germany. To achieve these goals, a national diabetes surveillance system is currently being established under the auspices of the RKI.
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Affiliation(s)
- Christin Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin
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Röttger J, Blümel M, Busse R. Selective enrollment in Disease Management Programs for coronary heart disease in Germany - An analysis based on cross-sectional survey and administrative claims data. BMC Health Serv Res 2017; 17:246. [PMID: 28372554 PMCID: PMC5379615 DOI: 10.1186/s12913-017-2162-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background In 2002, Disease Management Programs (DMPs) were introduced within the German healthcare system with the aim to increase the quality of chronic disease care. Due to the enrollment procedures, it can be assumed a) that only certain patients actively decide to enroll in a DMP and/or b) that only certain patients get the recommendation for DMP enrollment from their physician. How strong this assumed effect of self- and/or professional selection is, is still unclear. Methods We used data from a cross-sectional postal-survey linked on individual level with administrative claims data from a German sickness fund. The sample consisted of individuals suffering from coronary heart disease (CHD) who i) were either enrolled in the respective DMP or ii) fulfilled the disease related criteria for enrollment but were not enrolled. We applied multivariate logistic regression analyses to assess factors on patient level associated with DMP enrollment. Results We included 7070 individuals in our analyses. Male sex, higher age and receiving old age pension, a higher Charlson Score and a diagnosis of type 2 diabetes increased the odds for DMP-CHD enrollment significantly. Individuals with a diagnosed myocardial infarction (MI) were also more likely to be enrolled in the DMP-CHD. We found a significant interaction effect for MI and sex, indicating that the association between MI and DMP enrollment is stronger for women than for men. Conclusion DMP-enrollees and non-enrollees differ in various factors. Studies analyzing the effectiveness of DMP-CHD should carefully take into account these group differences. Furthermore, the results suggest that the DMP-CHD assessed reaches men better than women.
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Affiliation(s)
- Julia Röttger
- Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany.
| | - Miriam Blümel
- Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany
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Heidemann C, Kuhnert R, Born S, Christa SN. 12-Month prevalence of known diabetes mellitus in Germany. JOURNAL OF HEALTH MONITORING 2017; 2:43-50. [PMID: 37151307 PMCID: PMC10161271 DOI: 10.17886/rki-gbe-2017-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Diabetes mellitus is a metabolic disease involving chronic dysfunction of blood sugar regulation; if left untreated, it can result in serious secondary illnesses. In 2014 and 2015, a total of 7.0% of women and 8.6% of men in Germany with an age of 18 and over reported having diabetes mellitus in the past 12 months (these figures do not include gestational diabetes). There are significant differences in the 12-month prevalence among adults: the prevalence of known diabetes increases significantly with age, and is particularly high among people with a low educational status and those living in Saxony-Anhalt or Brandenburg. The Robert Koch Institute is currently developing a diabetes surveillance system in order to establish a data-based fundament for guiding health policy decisions in Germany.
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Affiliation(s)
- Christin Heidemann
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Berlin, Germany
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Kostev K, Rockel T, Jacob L. Impact of Disease Management Programs on HbA1c Values in Type 2 Diabetes Patients in Germany. J Diabetes Sci Technol 2017; 11:117-122. [PMID: 27246670 PMCID: PMC5375061 DOI: 10.1177/1932296816651633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim was to analyze the impact of disease management programs on HbA1c values in type 2 diabetes mellitus (T2DM) patients in Germany. METHODS This study included 9017 patients followed in disease management programs (DMPs) who started an antihyperglycemic treatment upon inclusion in a DMP. Standard care (SC) patients were included after individual matching (1:1) to DMP cases based on age, gender, physician (diabetologist versus nondiabetologist care), HbA1c values at baseline, and index year. The main outcome was the share of patients with HbA1c <7.5% or 6.5% after at least 6 months and less than 12 months of therapy in DMP and SC groups. Multivariate logistic regression models were fitted with HbA1c level as a dependent variable and the potential predictor (DMP versus SC). RESULTS The mean age was 64.3 years and 54.7% of the patients were men. The mean HbA1c level at baseline was equal to 8.7%. In diabetologist practices, 64.7% of DMP patients and 55.1% of SC patients had HbA1c levels <7.5%, while 23.4% of DMP patients and 16.9% of SC patients had HbA1c levels <6.5% ( P values < .001). By comparison, in general practices, 72.4% of DMP patients and 65.7% of SC patients had HbA1c levels <7.5%, while 29.0% of DMP patients and 25.4% of SC patients had HbA1c levels <6.5% ( P values < .001). DMPs increased the likelihood of HbA1c levels lower than 7.5% or 6.5% after 6 months of therapy in both diabetologist and general care practices. CONCLUSION The present study indicates that the enrollment of T2DM patients in DMPs has a positive impact on HbA1c values in Germany.
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Affiliation(s)
- Karel Kostev
- IMS Health, Frankfurt, Germany
- Karel Kostev, DMSc, PhD, IMS Health, Epidemiology, Darmstädter Landstraße 1089, 60598 Frankfurt am Main, Germany.
| | | | - Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
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Mehring M, Donnachie E, Bonke FC, Werner C, Schneider A. Disease management programs for patients with type 2 diabetes mellitus in Germany: a longitudinal population-based descriptive study. Diabetol Metab Syndr 2017; 9:37. [PMID: 28529546 PMCID: PMC5437566 DOI: 10.1186/s13098-017-0236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The primary aim of the disease management program (DMP) for patients with diabetes mellitus type 2 is to improve the quality of health care and the treatment process. 12 years after its introduction in Germany, there is still no consensus as to whether DMP has been effective in reaching these goals. METHODS A retrospective longitudinal population-based study between 2004 and 2015 were conducted to evaluate the DMP for type 2 diabetes in Bavaria using routinely collected patient medical records hold from the National Association of Statutory Health Insurance Physicians of Bavaria. RESULTS During the first 12 years of DMP, the number of participants increased continually to reach 580,222 in 2015. The proportion of participants older than 70 years increased during the observation from 41.6 to 51.1%. The percentage of smokers increased slightly from 9 to 11%. Similarly, the distribution of body mass index remained constant with approximately 50% of patients having a body mass index >30 kg/m2. Control of HbA1c was without an appreciable change over the course, with between 8.3 and 9.4% of all patients with uncontrolled values higher than 8.5%. Prescription of metformin increased from 40.5% in 2004 to 54.1% in 2015. Among patients receiving insulin, the proportion receiving a combined therapy with metformin increased from 28.4% in 2004 to 50.8% in 2015. In contrast, the percentage with insulin monotherapy decreased from 55.4 to 33.7%. The proportion of patients with a diabetic education increased within the course from 12.8 to 29.3%. CONCLUSION Data from the German DMP for type 2 diabetes demonstrates an improvement in the quality of care with respect to pharmacotherapy and patient education and therefore to an improved adherence to guidelines. However, no appreciable improvement was observed with regard to smoking status, obesity or HbA1c control.
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Affiliation(s)
- Michael Mehring
- Institute of General Practice, Technische Universität München, Orleansstraße 47, 81667 Munich, Germany
| | - Ewan Donnachie
- Association of Statutory Health Insurance Physicians of Bavaria, Elsenheimerstraße 39, 80687 Munich, Germany
| | - Florian Cornelius Bonke
- Institute of General Practice, Technische Universität München, Orleansstraße 47, 81667 Munich, Germany
| | - Christoph Werner
- Institute of General Practice, Technische Universität München, Orleansstraße 47, 81667 Munich, Germany
| | - Antonius Schneider
- Institute of General Practice, Technische Universität München, Orleansstraße 47, 81667 Munich, Germany
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Laxy M, Knoll G, Schunk M, Meisinger C, Huth C, Holle R. Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies. PLoS One 2016; 11:e0164704. [PMID: 27749939 PMCID: PMC5066975 DOI: 10.1371/journal.pone.0164704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Little is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014. Methods Analyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999–2001, n = 150), F4 (2006–2008, n = 203), FF4 (2013/14, n = 212) cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD) risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease. Results From 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001) increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management. Conclusion Despite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self-) care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care improvements cannot be ruled out.
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Affiliation(s)
- Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- * E-mail:
| | - Gabriella Knoll
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Informatics, Biometrics and Epidemiology, Ludwig-Maximilians- Universität München, Munich, Germany
| | - Michaela Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Huth
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Riedl R, Robausch M, Berghold A. The Evaluation of the Effectiveness of Austrians Disease Management Program in Patients with Type 2 Diabetes Mellitus - A Population-Based Retrospective Cohort Study. PLoS One 2016; 11:e0161429. [PMID: 27532885 PMCID: PMC4988720 DOI: 10.1371/journal.pone.0161429] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 08/05/2016] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the effectiveness of the Austrian Disease Management Program (DMP) 'Therapie aktiv-Diabetes im Griff' for patients with type 2 diabetes mellitus concerning patient-relevant outcomes (mortality, myocardial infarction and stroke) and costs. METHODS Based on routine health insurance data, we conducted a population-based retrospective cohort study using a propensity score (PS) matched control group design. The DMP-group consists of participants enrolled in the program during 2008 and 2009 (n = 7181). Out of 208.532 patients with no participation in the DMP up to 2013, PS-matched controls were selected with a matching ratio 1:3. In the PS-model, patient's characteristics, form of antidiabetic drug therapy, several prescriptions, the number of hospital admissions and days, main discharge diagnoses and costs at baseline were included. RESULTS Over a follow-up period of four years, we observed a significantly lower mortality rate in the DMP-group (9.4%) in comparison with the control group (15.9%, p<0.001). The cumulative number of hospital days and mean annual hospital costs were lower for DMP-participants resulting in significantly lower mean annual total costs, amounting to € 8226.80 per patient in the DMP-group and € 9231.10 in the control group respectively (p<0.001). CONCLUSIONS The evaluation shows a survival benefit and an average reduction of costs for participants in the DMP compared with the control-group. Despite we took great effort to ensure comparable groups, we cannot entirely rule out an influence by residual and unmeasured confounding due to the observational study design and the use of routine data. However, the results indicate that the disease management program implemented in Austria improves quality of care for patients with type 2 diabetes mellitus.
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Affiliation(s)
- Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Martin Robausch
- Controlling Department (ÄIRCON), Lower Austria Health Insurance Fund, St. Pölten, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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Lopez JMS, Katic BJ, Fitz-Randolph M, Jackson RA, Chow W, Mullins CD. Understanding preferences for type 2 diabetes mellitus self-management support through a patient-centered approach: a 2-phase mixed-methods study. BMC Endocr Disord 2016; 16:41. [PMID: 27430259 PMCID: PMC4950768 DOI: 10.1186/s12902-016-0122-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 07/04/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) who participate in diabetes management programs have been shown to have better glycemic control and slower disease progression, although program participation remains low. In the USA, increasing participation in diabetes management support programs may also directly impact provider reimbursement, as payments are increasingly based on patient-centered measures. However, little is known about factors that may enhance patient participation. This study aimed at further understanding what is important in diabetes management support from the patients' perspective and at assessing the utilization of various types of diabetes-management programs. METHODS A two-phase mixed-methods study was conducted of adult US members of PatientsLikeMe®, an online research network of patients. Phase 1 comprised qualitative interviews with 10 individuals to inform the online survey's contents, aided by literature review. During phase 2, this online survey was completed by 294 participants who reported on their diabetes goals and preferences for T2DM self-management support programs. RESULTS The majority of the respondents were not participating in any program (65 %), but most had goals of improving diet (77 %), weight loss (71 %), and achieving stable blood glucose levels (71 %). Among those currently participating in programs, clinic, hospital-based, or other health-care professional programs were the most commonly used (51 %). The most preferred type of support was diet/weight-loss support (62 %), while doctors or nurses (61 %) and dietitians (55 %) were the most preferred sources of diabetes support. CONCLUSIONS The low participation in diabetes self-management programs revealed in this study underscores the need for strategies to improve patient engagement. The results revealed support types and formats that patients with T2DM prefer and need. These findings may help improve patient engagement by guiding the future design of more effective diabetes management support programs.
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Affiliation(s)
- Janice M S Lopez
- Janssen Scientific Affairs, LLC, 1000 US Route 202 South, Raritan, NJ, 08869, USA.
| | - Bozena J Katic
- PatientsLikeMe Inc., 155 Second Street, Cambridge, MA, 02141, USA
| | | | - Richard A Jackson
- Harvard Medical School, 50 Milk Street, 17th floor, Boston, MA, 02109, USA
| | - Wing Chow
- Janssen Scientific Affairs, LLC, 1000 US Route 202 South, Raritan, NJ, 08869, USA
| | - C Daniel Mullins
- University of Maryland School of Pharmacy, Saratoga Building, 12th Floor, 220 Arch Street, Baltimore, MD, 21201, USA
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Litmathe J. [Health care economic guidance in Germany from the example Morbi-RSA]. Wien Med Wochenschr 2016; 166:182-7. [PMID: 26762261 DOI: 10.1007/s10354-015-0422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
Abstract
Increasing costs in health care represent still a major challenge in most industrial contries. A lot of attempts especially in Germany have been made to manage such problems and for a fair allocation oft he underlying resources. One of this ist the Morbi-RSA. The current review reflects all historical, medical and economical aspects of the Morbi-RSA and gives a perspective to possible future developments.
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Affiliation(s)
- Jens Litmathe
- Klinik für Neurologie, Klinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Du Y, Heidemann C, Schaffrath Rosario A, Buttery A, Paprott R, Neuhauser H, Riedel T, Icks A, Scheidt-Nave C. Changes in diabetes care indicators: findings from German National Health Interview and Examination Surveys 1997-1999 and 2008-2011. BMJ Open Diabetes Res Care 2015; 3:e000135. [PMID: 26629347 PMCID: PMC4653864 DOI: 10.1136/bmjdrc-2015-000135] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/15/2015] [Accepted: 10/09/2015] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To investigate changes in type 2 diabetes care indicators over time in Germany. METHODS Adults aged 45-79 years with type 2 diabetes were identified from two national health examination surveys conducted in 1997-1999 (GNHIES98, n=333) and in 2008-2011 (DEGS1, n=526). We examined diabetes care indicators including treatment and preventive targets (glycemic control, blood pressure (BP), total cholesterol (TC), smoking, weight reduction, sports activity), self-management and care process measures (glucose self-monitoring, holding a diabetes passport, annual foot and eye examination; statin use), and the presence of diabetes-specific complications (diabetic nephropathy, retinopathy, neuropathy, diabetic foot, amputations) and comorbid cardiovascular disease (CVD) or chronic kidney disease (CKD). We calculated proportions of persons meeting these care indicators by survey and examined unadjusted and adjusted changes between surveys. RESULTS Significant improvement (GNHIES98 vs DEGS1) over time was observed for glycated hemoglobin (HbA1c) <7.0% (53 mmol/mol) (32.4% vs 65.4%), BP <130/80 mm Hg (32.0% vs 47.2%), TC <190 mg/dL (13.5% vs 41.9%), statin use (11.7% vs 35.9%), eye (51.1% vs 78.4%) and foot (48.0% vs 61.4%) examination within the past 12 months, diabetes-specific complications (29.7% vs 21.8%), and CVD (44.5% vs 37.1%). Blood glucose self-monitoring significantly increased (37.4% vs 62.8%), while holding a diabetes passport did not change. Current smoking did not change and obesity rose, although sports activity significantly increased over time. Proportions of adults achieving combination goals of HbA1c, BP, TC, and smoking cessation were low in both surveys in spite of significant improvement. CONCLUSIONS In Germany, the quality of diabetes care improved over time. There is much room for improvement, in particular regarding preventive goals and diabetes self-management.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | | | - Amanda Buttery
- King's College London , Faculty of Life Sciences and Medicine , London , UK
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Thea Riedel
- Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
| | - Andrea Icks
- Jean Philippe Assal Group for Health Services Research and Health Economics , German Diabetes Center , Düsseldorf , Germany ; Public Health Unit, Faculty of Medicine , Heinrich-Heine University , Düsseldorf , Germany ; German Centre for Diabetes Research (DZD) , Munich , Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring , Robert Koch Institute , Berlin , Germany
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Laxy M, Stark R, Meisinger C, Kirchberger I, Heier M, von Scheidt W, Holle R. The effectiveness of German disease management programs (DMPs) in patients with type 2 diabetes mellitus and coronary heart disease: results from an observational longitudinal study. Diabetol Metab Syndr 2015; 7:77. [PMID: 26388948 PMCID: PMC4574141 DOI: 10.1186/s13098-015-0065-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM) and coronary heart disease (CHD) are among the biggest worldwide, evidence on the effectiveness of these programs is still inconclusive or missing, particularly for high risk patients with comorbidities. The objective of this study was therefore to analyze the impact of DMPs on process and outcome parameters in patients with both, type 2 DM and CHD. METHODS Analyses are based on two postal surveys of patients from the KORA myocardial infarction registry (southern Germany) with type 2 DM and on two postal validation studies with patients' general physicians (2006, n = 312 and 2011, n = 212). The association between DMP enrollment (being enrolled in either DMP-DM or DMP-CHD) and guideline care (defined by several process indicators) at baseline (2006) and its development until follow-up (2011) was analyzed using logistic regression models accounting for the repeated measurements structure. The impact of DMP enrollment/guideline care on cumulated (quality-adjusted) life years ((QA)LYs) over a 4-year time horizon (2006-2010) was assessed using multiple linear regression methods. Logistic regression models were applied to analyze the association between DMP status and patient self-management at follow-up. RESULTS Being enrolled in a DMP was associated with better guideline care at baseline [OR = 2.3 (95 % CI 1.27-4.03)], but not at follow-up [OR = 0.80 (95 % CI 0.40-1.58); p value for time-interaction <0.01]. DMP enrollment was not significantly [+0.15 LYs (95 % CI -0.07, 0.37); +0.06 QALYs (95 % CI -0.15, 0.26)], but treatment according to guideline care significantly [+0.40 LYs (95 % CI 0.21-0.60); +0.28 QALYs (95 % CI 0.10-0.45)] associated with higher (quality-adjusted) survival over the 4-year follow-up period. DMP enrollees further reported a somewhat better self-management than patients not being enrolled into a DMP. CONCLUSIONS The results of this study concerning the effectiveness of DMPs in patients with DM and CHD are mixed, but are weakly in favor of DMPs. However, we found a clear positive impact of guideline care on quality adjusted survival in this patient group. The development of the association between DMP enrollment and guideline care over the follow-up time indicates some external effects, which should be the subject of further investigations.
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Affiliation(s)
- Michael Laxy
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />German Center for Diabetes Research, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Renée Stark
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Christa Meisinger
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Inge Kirchberger
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Margit Heier
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Wolfgang von Scheidt
- />Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Rolf Holle
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />German Center for Diabetes Research, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
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Fuchs S. In reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:136. [PMID: 25759981 PMCID: PMC4361804 DOI: 10.3238/arztebl.2015.0136b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Sabine Fuchs
- *Technische Universität Berlin, Fachgebiet Management im Gesundheitswesen, Berlin,
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Mengersen R. Only health insurances are interested. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:136. [PMID: 25759980 PMCID: PMC4361803 DOI: 10.3238/arztebl.2015.0136a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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