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German Diabetes Disease Management Programs Are Appropriate for Restructuring Care According to the Chronic Care Model

An evaluation with the Patient Assessment of Chronic Illness Care instrument

From the Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany

Corresponding author: Joachim Szecsenyi, MD, MSc, Professor and Head, Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vosstrasse 2, D-69115 Heidelberg, Germany. E-mail: joachim.szecsenyi{at}med.uni-heidelberg.de

OBJECTIVE—With the introduction of diabetes disease management programs (DMPs) in Germany, there is a necessity to evaluate whether patients receive care that is congruent to the Chronic Care Model (CCM) and evidence-based behavioral counseling. We examined differences as perceived and experienced by patients with type 2 diabetes between those enrolled in a DMP compared with patients receiving usual care in two federal states of Germany.

RESEARCH DESIGN AND METHODS—A random, heterogeneous sample of 3,546 patients (59.3% female) received a mailed questionnaire from their regional health fund, including the German version of the Patient Assessment of Chonic Illness Care (PACIC) instrument, which had additional items for behavioral advice (5A). Two weeks later, a general reminder was sent out.

RESULTS—A total of 1,532 questionnaires were returned (response rate 42.2%), and valid data could be obtained for 1,399 patients. Mean age of responders was 70.3 years, of which 53.6% were female. Overall, patients enrolled in a DMP scored significantly higher (3.21 of a possible 5) than patients not enrolled in a DMP (2.86) (P < 0.001). Significant differences in the same direction were found on all five subscales of the PACIC. For the 5A scales, similar differences were found for all five subscales plus the sum score (P < 0.001; mean for DMP = 3.08, mean for non-DMP = 2.78).

CONCLUSIONS—DMPs, as currently established in primary care in Germany, may impact provided care significantly. The changes in daily practice that have been induced by the DMPs are recognized by patients as care that is more structured and that to a larger extent reflects the core elements of the CCM and evidence-based counseling compared with usual care.

Abbreviations: CCM, Chronic Care Model • DMP, disease management program • ELSID, Evaluation of a Large-Scale Implementation of Disease management programs • PACIC, Patient Assessment of Chronic Illness Care

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