[One and a Half Decades of Disease Management Programs - Status Quo From the Point of View of General Practitioners].

BACKGROUND: In 2003, disease management programs (DMP) were established to improve the care of chronically ill outpatient patients. Since then, there has been a lot of controversy over the meaning and benefits of structured treatment programs, especially among primary care physicians. The present study examines the attitudes and experiences of general practitioners in relation to DMP, how they assess these one and a half decades after their introduction, and where DMP need to be improved. METHODS AND PARTICIPANTS: In the course of a written survey, a total of 752 general practitioners in Hesse were interviewed between April and June 2019. In addition to the descriptive analysis, a factor analysis was performed.
RESULTS: 59 % of the interviewees assess the DMP as positive and consider it a useful contribution to primary care. 89 % are currently participating in one or more DMPs, with 52 % indicating that the treatment of patients included in DMP has benefited significantly. Respondents consider the provision of regular, structured patient care and the improvement of compliance to be particularly positive. It is also stated that the diagnostic and therapeutic knowledge could be extended by DMP participation. 58 % always follow the DMP therapy recommendations. Documentation requirements and frequent organizational changes to the programs are criticized. From the point of view of the respondents, a far-reaching rigidity of the DMP concept leads to an exaggerated narrowing of the scope for action and occasionally to complications in practice. The results show that the cooperation with specialist colleagues within DMP is often experienced as unsatisfactory. DISCUSSION: From a primary care point of view, a substantial improvement in DMP would mean a simplification of the documentation and administration effort, better regulated and smoother cooperation with other care levels, a greater degree of decision flexibility, a greater and more differentiated offer of compulsory training, and an increased involvement of primary care experience in the process of DMP development as well as a better reward. © Georg Thieme Verlag KG Stuttgart · New York.